Carson Wentz's injury: What is an ACL tear?

Quarterback Carson Wentz left the game with what was initially called a knee injury but revealed on Monday to be a season-ending ACL tear.

The ACL is a small piece of connective tissue inside the knee. Dr. Brian Sennett said a tear can occur as an athlete plants a foot and pivots.

"So he may have his foot planted, the body rotates, and that is where the ACL tears," Sennett said.

The good news is that it can be repaired. A strip of tendon can be cut from elsewhere in the body and become a graft. Holes are drilled above and below the knee, and the graft is threaded through the holes.

The graft is then anchored by screws and in time, Sennett says, the replacement ACL will actually be stronger than the original.

"This is an injury that will require surgery, it will require rehabilitation, but you expect him to be back on the playing field next year and make a full recovery," said Sennett.

Within days, maybe hours of the surgery, Wentz will likely be up and physical therapy will begin, says Penn Medicine's Justin Shaginaw.

"They start right away with a stationary bike, weight training, range of motion to reduce swelling and progressing from there to balance exercises," Shaginaw said.For top athletes like Wentz, the therapy will be intense, but studies show NFL QB's have a high recovery rate

ACL tears are fairly common in the United States, with some 100,000 cases per year.

The outside of Maggie Lucas’ left arm offers a message, added last year at a South Street tattoo joint. For when I am weak, then I am strong.

​Lucas already knew the biblical turn of phrase. It earned extra points and a spot on her arm after surgery for a torn right anterior cruciate ligament.

Locating weakness in this particular basketball player would be a chore. The words, however, speak to Lucas again, preparing now for her second ACL surgery in 14 months, same right knee.

You don’t dream about this growing up. All the hours that got you to the WNBA — the pre-dawn shooting in an empty gym before classes at Germantown Academy, the ball handling drills that turned your Narberth basement into a personal Palestra — you can’t envision they also lead here, just off the lobby of the Curtis Building, 7th and Walnut, your sweat no longer about a dream but the reality of being an injured professional.

“My work has always been: I’m going to run through a wall to get what I want,” Lucas said as she warmed up for a 90-minute physical therapy session Tuesday by riding 20 minutes on a stationary bicycle. Now, the 25-year-old must take time to examine the wall. Her work still would exhaust most species. She’d already been to a gym in Havertown, did some cardio work, some upper-body strength work. Her day includes touch shooting on her driveway, ball handling work in her basement. She believes that was important after her first surgery.

​“I never felt like I lost my form, lost my touch,’’ Lucas said. “I kept the ball in my hands. I never lost that.”​

Lucas and her recovery team believe the former two-time Big Ten player of the year at Penn State had been savvy in not rushing back to the Indiana Fever, completing each stage of recovery.

“Going up for a layup, I just kind of landed funny,” Lucas said of her second ACL tear on April 6, 10 months post-surgery.

A month later, she was waived by the Fever.

“The Fever stood by me last year,” Lucas said. “They could have cut me after my first injury. They stood by me, which I wasn’t expecting. I understood this year: They have to let me go, from the business side of things.”

Because of all her local success — she’s on any short list of great ones from around here — it’s easy to disregard the narrowness of the path Lucas took to the WNBA.

“Every level you go up, the pool just gets more and more competitive — it’s like a funnel,” Lucas said. “I think sometimes people are a little unrealistic about how hard it is to make a WNBA team. There’s 144 spots and the whole world is going for them.”

Lucas knew going in that being drafted in the second round by Phoenix in 2014 guaranteed nothing. (None of the six players drafted directly ahead of her are in the WNBA). Further into the funnel, 5-foot-10 shooting guards — there’s plenty of them.

“You go in with these expectations — I do my best and show what I’m capable of, I’ll be fine,’’ Lucas said. “When I got to Phoenix, there weren’t many of their big-name players in camp. You look around, you start doing number games — there’s 14 of us probably playing for two spots.”​That was before an established Eastern European shooting guard showed up on the last day of camp before a preseason tournament, a new roster addition.

File Photo
Penn State's Maggie Lucas (33) beats Indiana's Jasmine McGhee to a loose ball during a game in February 2012.

“I had two options at that point,” Lucas remembers. “Say, ‘Oh, well, there’s no spot.’ Or focus on getting myself to the preseason tournament and playing really well and hopefully getting seen by somebody else, since there’s probably no spot here.”

That’s how it played, last day of preseason. Indiana gave Phoenix a second-round choice for Lucas. This time she was the one who showed up the last day grabbing a spot.

“Phoenix did right by me,” Lucas said.

Her rookie season was about toughening up. There were some games where she felt like her Penn State self, in the flow, but she was a reserve fighting for minutes. Since the WNBA season is in the summer, Lucas joined the migration of women’s pros who go to Europe to play in the winter. She was in France, enjoyed it, but it was a grind, going from college to WNBA to European season back to WNBA, barely a break. She skipped Europe the next year, stayed home to work on her game, helped as an assistant at Germantown Academy.​Fate would have it, the rest preceded her first significant injury last May. She had earned more minutes, averaging 7.8 points through Indiana’s first four games, had led the Fever with 12 points that day before going down in the final seconds of the third quarter.

​​“I never envisioned the injury side of it,” Lucas said. “When you’re going along — you haven’t had any injuries — you start to feel pretty invincible.”

On Tuesday, Lucas was catching a lightly weighted ball, whipping it around her back and over to her physical therapist, a timeless game of catch. Except she was positioning her legs on a circular board, an upside-down Bosu ball that could send her to the ground at the slightest imbalance. Other drills: Cutting off blood supply out of your injured leg, allowing you to do resistance work with less weight on your leg. Semi squats. Heel slides. Step-ups. She got the music choice and went with reggae, Stick Figure singing about the school for you and me.​

“This is only a quarter to third of her daily work,” said Justin Shaginaw, lead therapist and coordinator of sports medicine at 3B Orthopaedics, who also works with the U.S. men’s national soccer team among other elite athletic clients.Dealing with torn ACLs is all too common, especially among elite female athletes.

“I remember one time I looked at my Indiana Fever and like eight of the 12 girls on the roster had torn their ACLs, some twice,” Lucas said. “Our game just gets more and more athletic, and faster and stronger, but the injuries are still going to happen. Luckily, bouncing back is possible.”

She had bone graft surgery on May 9, and has to wait three months before they can go back in and repair and reconstruct the ACL.Getting Lucas to slow down a bit is part of his job, Shaginaw said. Not easy for top athletes, he knows. Research done by academics from the University of Delaware and in Oslo, Norway, found that re-injury rates after ACL reconstruction went down 51 percent each month up to nine months. Shaginaw, familiar with the research, said your rate can drop to as low as 6 percent by waiting at least the nine months.

JEFFREY BROWN / Icon Sportswire

That doesn’t prevent Lucas from a re-injury, obviously. The flukiness of it only added to the frustration.

“We’re still missing something,’’ Shaginaw said, although he remembers how Lucas did the right things last year, and by taking her recovery in stages she could practically broad jump across his room by the end of it.

“They were amazed at how you looked,” Shaginaw said of Lucas returning to Indiana earlier this year. “What was that, 8 ½ months?”

She still hadn’t been cleared for full-time, full-court play when the second injury occurred.

“I was putting everything I had on that knee,” Lucas said of the tests she had undergone. “And like one weird step and it went. You can test it, and pass every test, and I think it was just some bad luck.”

But she has been receptive to asking questions, even if there are no obvious answers.

“I’m going to tell you she did it right. But what do we need to address and change?” asked her strength and conditioning coach, Jim Ferris, who worked with Kyle Korver and other NBA pros for years. “You’re not unbreakable. They’re not easy conversations.”

Especially hard when you see the results.

“She can squat 250 and has shredded abs,” Ferris said.

Lucas, Ferris and Shaginaw talk about whether the routine that got to the WNBA still is the exact right recipe.

“You shoot 98 percent in your practice?” Ferris said. “What’s it do? What’s a thousand shots a day for you?”

Not just for Lucas. In general.​“It’s a big thing in all pro sports,” Shaginaw said. “There’s as much value in rest as there is in training. Some NBA teams have stopped the morning shootarounds. I think it was the Cubs who stopped getting to the ballpark so early.”

SHARON GEKOSKI-KIMMEL / Staff File Photo
Germantown Academy's Maggie Lucas drives during a game against Notre Dame in January 2009.

​Lucas hears all that. She’s not fighting it. Getting through a wall isn’t the only way past it.

“If we can’t be ready on game day, and get ourselves ready, that’s our problem,” Lucas said of the value, for instance, of shootarounds.

Her own next WNBA stop will be a free-agent tryout. She’d love to get another shot next year in Indiana. In her mind, that’s still her team. For now, she stays busy. She was headed Tuesday to a gym for a private training session with a high school player. The session isn’t about Lucas, so unless that tattoo or something sparks a question, her own journey may not come up, even when she was in high school herself.

“I was just always such a gym rat,” Lucas said. “I had a basketball with me all the time. I would be in the gym probably eight hours a day. That’s not even an exaggeration. Free periods, I would go to the gym. I’d get to school early and and shoot at five o’clock in the morning. I’d stay after school, I”d play pickup with the guys. We had a good group. We’d stay every day after school, stay late at night.”

Were some of the guys there before school, too?

“No,” Lucas said.

Tutoring a teenager, would she throw everything at her that she once threw at herself?

“No,” Lucas said with a laugh, her own physical therapy session almost over. “Not right away at least.”

8 STUDENT-ATHLETES FACE RARE, SERIOUS ILLNESS IN TEXAS

​6ABC WPVITuesday, August 23, 2016Health officials in Texas are trying to figure out how eight student-athletes were all sent to the hospital facing symptoms of a rare and serious illness.

The students are all from Texas Women's University, six are on the volleyball team.

The illness is called rhabdomyolysis or rhabdo.

It's a break-down of muscle tissue and can cause kidney damage.

Local physical therapist Justin Shaginaw is not involved in the cases, but says eight at one school points to some common causes.

"The two conclusions could be that they're taking supplements that predispose them to it or they were training in excess without opportunity for rest, hydration, cooling, those types of things," Shaginaw said.

Meeting in Miami discusses anti-doping at the Copa America

﻿(FIFA.com) 02 May 2016

​The Copa America Centenario 2016 Medical and Anti-Doping Committee met with experts from the FIFA Medicine & Science Department and UEFA in Miami on Friday 29 April for a workshop to finalise a unified and consistent structure for anti-doping policies and procedures to be used during the historic tournament.

Dr Osvaldo Pangrazio, chairman of the committee, led the workshop along with co-chairman Dr Bert Mandelbaum and U.S. Soccer Medical Coordinator Hughie O’Malley. Medical experts and doctors from all the participating venues were in attendance, along with five members of the CONCACAF anti-doping committee and five from CONMEBOL.

The Committee presented information regarding anti-doping measures for the tournament; educating each of the venue medical teams about the specific process for testing during the event.

Earlier in the year, an agreement between CONCACAF, CONMEBOL and FIFA was reached to bring together the medical teams from the two regional governing bodies for the 100th anniversary of the Copa America, which will be played outside of South America for the first time.

LAST-MINUTE TIPS TO PREPARE FOR SUNDAY'S BROAD STREET RUN

﻿6ABCBy Ali Gorman, RNFriday April 29, 2016On Friday, runners were picking up their race bibs, packets and t-shirts and some were doing their best to calm pre-race jitters. Others are watching the forecast. But since we can't control the weather, experts suggest to focus on what you can control. Justin Shaginaw and Dr. Todd McGrath from the Aria 3B Orthopaedic Institute say by now training should be over. On Saturday what's recommended for activity depends on your level of experience. "If you're a novice, maybe just go for a walk. If experienced, a light run 2-3 miles to get legs ready for the next day," said Shaginaw. Over the weekend stay hydrated, but come Sunday morning be careful not to over-hydrate. "You don't need to drink a gallon of water. A normal glass of water or maybe an electrolyte drink to sip on walking around the starting area," said Dr. McGrath. And if you find yourself a little unprepared this year, then lower your expectations, take it slow and listen to your body. As for running gear, if you bought fancy new running clothes, save them for another day. "Don't switch shoes especially, no inserts keep same running clothes because one little thing can really set you up for a problem," said Shaginaw.Good luck to all the runners!By Ali Gorman, R.N.

Every team in the NFL cares about injury, but the Philadelphia Eagles put more emphasis on preventative medicine than most. Chip Kelly's sports science program is shrouded in mystery, but what little we do know about it seems to say that the Eagles are interested in curbing muscle injuries through monitoring and prevention.

And yet, there have been several injuries to the Eagles this season. In last week's loss to the Cowboys the Eagles suffered several key injuries, including Kiko Alonso and Mychal Kendricks. And earlier in the week, running back DeMarco Murray suffered a hamstring injury during practice.

To help us sift through all the injury news, we've partnered with Dr. Arthur Bartolozzi, former team physician for the Philadelphia Eagles and Flyers and current director of sports medicine at 3B Orthopaedics at Aria Health, as well as Justin Shaginaw MPT, ATC, former team physical therapist for the Philadelphia Charge and the Philadelphia Kixx, and current physical therapist and coordinator of sports medicine for 3B Orthopaedics at Aria Health and athletic trainer with the US Soccer Federation.

We spoke with these two experts about the Eagles' recent injuries, and more. To hear the audio version, check out this week's episode of BGN Radio:What is an ACL tear?

Dr. Arthur Bartolozzi: A ligament is made of a number of fibers. And the ACL has a number of complex fibers that all function to stabilize. When [the knee] becomes unstable, it can rotate more than its supposed to, or twist more than it's supposed to. And it can actually twist enough to make the player feel like the knee is insecure or comes out of joint.

When you tear a ligament, a sprain is technically a tear. So we grade the sprain based on how much tearing there is. If there's a little bit of tearing, there's no looseness. If there's a lot of tearing or a complete tear, there's a lot of looseness. So we grade that 1, 2, 3. Most types of sprains we diagnose are in the range of 1 or 2, where there may be a little bit of pain; a little bit of weakness or a little bit of looseness.

What does it mean when a player gets a second opinion?

AB: Sometimes you want to have an opinion from someone who's not intimately involved with the process. A lot of players, while they have confidence in their medical staff and doctors, sometimes want to have another set of eyes. And when I was working with the Eagles, I welcomed other opinions, because I thought it would be helpful to really instill confidence in the player, and to make sure the player is aware of exactly what we're telling them is exactly what's being said. And that's not always the case.

And so if there's a difference of opinion, then it creates a venue for discussing. "Hey, what's up? Why are there differences?" But really it's mostly so the player has confidence in the direction he has to go.

AB: Well, let's talk about this particular player. This is a very tricky process. Grade 2 determined by MRI is different than Grade 2 determined by a physical examination. Sometimes these ligaments, even after being replaced, don't appear entirely normal on the MRI scan. And Grade 2 means there's some laxity in the knee, or some looseness in the knee, that may not have been there before.

So partial tearing, but not a complete tear, where the fibers are completely disrupted and the knee is totally loose. But sometimes a partial tear results in looseness that places you at risk for further injury, or looseness that the player can proceed with. And sometimes, players can play with a certain amount of looseness and never even notice it.

So some of it is going to be based on the examination of his knee and checking out how loose it is, and then how does the player feel when using that knee? Most ACL surgeries restore the knee to near-normal, and not exactly normal. But it's close enough that players can play without a problem.

AB: Hamstrings are a significant problem. Muscle injuries in general are significant problems in sports. There have been some studies that show that if you have 25 players on a team, you can expect 15 muscle injuries. If you have 50 players, you can expect 30 muscle injuries. And these really account for most of the time missed in playing football. So whether it's a bruised muscle or a strained muscle, muscles are injured.

The reason why hamstrings get injured is because the muscle, as it attaches to the tendon, is so strong that it actually exceeds the normal ability of that stuff to stay attached, so they rip off a little bit. It rips off, it causes pain, causes a little bleeding. And it hurts!​What places you at an increased risk for muscle injury is fatigue. And so a lot of these injuries occur either toward the end of the half or the end of the game, or in practice after an extensive practice, or the next day after an extensive practice. So fatigued muscles have a higher risk of injury. So previous injury also places you at increased risk. And most of these hamstring injuries are relatively minor muscle tears. They're not significant to the point where the muscle tears off the bone.

The large majority of these injuries are graded from Grade 0, which means you can't even see it on an MRI scan, or Grade 1, where there's just a little bit of swelling but no obvious tearing. Those types of injuries account for the most common causes of injury. And there are serious ones, where you've seen players miss half or all of the season with serious injury. So most are minor.

In DeMarco Murray's case, as is the case with most of these injuries, it takes a week or two to get back to physical activity. And players often know where they stand, having had previous injuries like that.

What is sports science, and can Chip Kelly's program really prevent injuries?

Justin Shaginaw: Across all sports they're really trying to use sports science to limit injuries and improve performance. You can see this with the NBA starting to use metrics now. Soccer, we've used it a little bit longer than the NFL, looking at heart rate monitors and work load and that kind of thing.

Sports science is really trying to find the balance between sure an athlete is as fit as possible without overtraining them. If you're not in shape, you're more likely to sustain injury, especially muscle strains. And if you're fatigued you're at more risk. And I think that's the sweet spot that all the sports science people are trying to figure out.

I think this is new to football, and if you look at fitness and football, it's a different animal than most other sports because if you look at the total work done in a football game, it's not a lot compared to a basketball game or a hockey match or a soccer match.

And I think Chip Kelly, with the increased plays, is trying to improve fitness over players. You may not see a return in investment of this for another two or three seasons until the players really buy in; they've gone through a season or two of the sports science program. I think that's really when you might start to see a payoff.

Eagles vs. Jets Preview: Eagles offense needs to get back on track to save the season

FOX 29 Eagles Update 8/2/15

Top Sports Medicine Experts from 3B Orthopaedics at Aria Health Tapped to Lead Medical Direction of 2015 CONCACAF Gold Cup Final

OrthoSpineNewsBy Paige Maier 7/27/15

Three of the area’s top sports medicine experts – all from the 3B Orthopaedics at Aria Health – will lead the overall medical direction of the 2015 CONCACAF Gold Cup Final on Sunday, July 26, 2015 at Lincoln Financial Field. Arthur R. Bartolozzi, MD, Director of Sports Medicine for 3B Orthopaedics will serve as Venue Medical Director (VMD); Matthew Hay, PA-C, ATC, will serve as Assistant Medical Director (AMD); and Justin Shaginaw, MPT, ATC, Coordinator of Sports Medicine, will provide coordination assistance and serve on stretcher crew.CONCACAF – the Confederation of North, Central America and Caribbean Association Football – hosts the Gold Cup, the confederation’s premier event for national teams, to honor a champion every two years. The 2015 Gold Cup Final on Sunday, July 26, 2015 at Lincoln Financial Field will crown the new CONCACAF champion. Bartolozzi, Hay and Shaginaw will be on-hand at this prestigious soccer event to provide medical coordination and assistance to participating teams, staff and officials.“It’s an honor to offer our medical assistance to this world renowned soccer final,” said Dr. Bartolozzi, Director of Sports Medicine for 3B Orthopaedics at Aria Health. “3B is an area leader in Sports Medicine, and we are thrilled to be working with the teams of CONCACAF as they compete for the 2015 Gold Cup title.”Part of the Aria Health system, the largest healthcare provider in Northeast Philadelphia and Lower Bucks County, 3B Orthopaedics offers its patients leading Orthopaedic care and specializes in Sports Medicine. The team of experts at the 2015 CONCACAF Gold Cup Final has vast experience in working with world-class athletes in almost every sport. Dr. Art Bartolozzi, Matt Hay and Justin Shaginaw have worked with many of Philadelphia’s professional sports teams, local colleges and universities, as well as the US Soccer Federation.For more information about 3B Orthopaedics at Aria Health or the Aria 3B Orthopaedic Institute locations, please call 1-888-ORTHO3B (678-4632) or visit ARIA3BORTHO.org.About 3B Orthopaedics at Aria Health:Recognized as leaders in their fields, the specialists of 3B Orthopaedics at Aria Health have over 100 years of combined experience with expertise in joint replacement for hip and knee, sports medicine, and comprehensive spine care. To learn more, visit ARIA3BORTHO.org or call 1-888-ORTHO3B.About Aria Health:Aria Health is the largest healthcare provider in Northeast Philadelphia and Lower Bucks County. With three leading-edge community hospitals and a strong network of outpatient centers and primary care physicians, Aria upholds a longstanding tradition of bringing advanced medicine and personal care to the many communities it serves. For more information about Aria Health please visit http://www.ariahealth.org“Like” Aria Health on Facebook at http://www.facebook.com/ariahealth“Follow” Aria Health on Twitter at @AriaHealth.

Maximizing Workout Results Without Getting Hurt

A local expert offers advice to help you see results during your workout without getting hurt.Finding the balance between pushing too hard and not pushing hard enough during your workout can be challenging. Sometimes, the mindset of "No pain, No gain" isn't always the way to go. A local expert has better advice to help you see results without getting hurt. Leo Wang has jumped right back into working out after not exercising much during the winter. Now, he's trying to make up for lost time. "I go pretty hard starting to play basketball again and go to the gym every day," said Wang. And he's not alone, many people along Kelly Drive tell us once the weather got nice, they went full speed ahead with fitness. "Springtime comes and you kind of want to consolidate and push to the limit, run a lot and work out a lot," said one runner.

Justin Shaginaw MPT, ATC, a physical therapist and athletic trainer at Aria 3B Orthopaedics, says the goal is to strike a balance. "If you push too far, you're going to have an injury. If you don't push too much then you won't see results. And that balance is different for every individual," said Shaginaw. He says common injuries this time of year include overuse or impact injuries such as shin splints, tendonitis and muscle strains. To avoid problems he says start slowly and gradually increase intensity. As for "No pain, No gain", Shaginaw says a better motto is no soreness, no gain. But there is a difference between being sore and being in pain. "If you had pain the next day where you have difficulty doing daily activities, getting dressed, walking stairs then once again something you did the day before was a problem," said Shaginaw. And he says if the pain doesn't go away after a few days, you should see your healthcare provider.

But if it's just soreness, that means your working your muscles the right way. However, you should still give them time to recover. "You usually want to wait until that soreness resolves before you exercise that muscle group again," said Shaginaw. But there is an exception to that. Within reason, he says you can work your core or abdominal muscles every day. They're a different type of muscle fiber and they're basically always working so it's hard to over-work them.

It happened midway through the third quarter of a Week 6 game.The New York Giants had tumbled down a deep, dark hole against the Philadelphia Eagles, from which there seemed no return. They trailed 20-0, a deficit that made Giants head coach Tom Coughlin crave quick points. A field goal on fourth down from Philly’s three-yard line was still a failure.Eying a desperately needed touchdown, the Giants lined up in a three-receiver set with Victor Cruz in the right slot. Quarterback Eli Manning waited for the snap in shotgun.Cruz stutter stepped before easily shaking Eagles cornerback Brandon Boykin on a corner route. He had a full step on Boykin, and at that point the play was routine: Cruz had to elevate slightly to secure both the ball and a touchdown.The result, however, was far from routine. Instead it was rare and excruciating.

Matt Rourke/Associated Press

When Cruz rose to meet the ball his right knee buckled. He didn’t face any contact from Boykin (or anyone), which was the first sign of coming injury doom. Then screaming in agony and not being able to put pressure on the leg were the next clues.

But this wasn’t just your garden-variety muscle rip. He tore his patellar tendon, which attaches the kneecap to the lower leg. Your understatement for today: The patellar tendon is pretty important for any fully functioning human body.

A 2011 study in the American Journal of Sports Medicine showed that between 1994 and 2004 there were only 21 patellar tendon ruptures in the NFL. That’s from Justin Shaginaw, an athletic trainer who writes for the Philadelphia Daily News. He also noted that it takes a force of roughly 17 times your body weight to tear the patellar tendon. Such a freak incident can come through contact, or in Cruz’s case, an awkward plant as he was generating the power to leap.

The initial timetable given for Cruz’s recovery was four-to-eight months. When he spoke to the media through a conference call less than a week after suffering the injury, the 28-year-old was determined to be ready for training camp and Week 1 of 2015.

"I don't have any doubt in my mind,” he said, via Jordan Raanan of NJ Advance Media. “I don't have any doubt that I'll be back.”

The salsa-dancing slot receiver is approaching the six-month mark in his recovery process now. He recently started jogging, and he also joined Manning at Duke University for an offseason workout.

So the mending is progressing as planned then, right? I started there in a conversation with Cruz that touched on his rehab process and a still-lingering drive from being an undrafted player.

Bleacher Report: You suffered a rare and severe knee injury. Where are you now in the recovery process? Is Week 1 still a realistic goal?Victor Cruz: Next week will be six months since surgery, and I’m feeling good. My leg is getting better and stronger every day. Week 1 is definitely still the goal, so we’re working every day to make sure we reach that goal.B/R: What’s been the toughest challenge in the recovery process?Cruz: Probably just a little bit of everything. Obviously, when you have surgery on your knee the atrophy kind of takes away all your muscles. It’s like starting from scratch and starting to build muscle around your knee while doing leg lifts, presses, squatting, box jumps and one-leg squats.You’re just building the entire hamstring, quad and VMO (note: If you want to impress your friends at parties, that’s the Vastus Medialis Oblique, and it’s one of four muscles that make up the quadriceps). All those muscles, you’re building them from scratch. Just having to do that every day, seeing results little by little and really being diligent and disciplined to the process is the hardest part.B/R: It sounds like you’ve reached a mindset and a positive one. Did it take you some time to reach that point immediately after the injury happened?Cruz: It took me time when the injury initially happened. I’ve never faced an injury like this before, and I didn’t know what to think. The biggest thing I was thinking about: my teammates.I couldn’t be around them as much as I wanted to. Obviously, while rehabbing in the training room I’d see them. But I couldn’t be around them in the way I was in weeks past, or in years past where I’d be there every day in meeting rooms and traveling.That was the first thing that went through my mind. Next was figuring out the best rehabilitation process, understanding my injury and understanding what the process was in terms of getting back to 100 percent health.

B/R: Often the physical aspect of an injury is obvious, but we overlook the mental hurdles. Being away from your teammates has been one of your toughest challenges then?Cruz: I love my teammates to death, and it was the first year of me being named team captain. Aside from winning a Super Bowl, that’s probably one of the greatest accomplishments I’ve had in my life. I’ve never been a captain on any team that I’ve ever been on.So to be captain of a professional football team with my teammates choosing me was significant. It was something I held very dear. Being away from them for that year was tough, and now I just want to come back, be around them, be stronger and be held accountable for my actions while continuing to be the captain they entrusted me to be.B/R: Before your injury you were part of a new-look offense that stumbled at first, then clicked. How much of an adjustment was Ben McAdoo’s system for you throughout training camp?Cruz: It was tough. The biggest challenge was the terminology, the verbiage and the vocabulary you have to learn, wrapping your head around that and then applying it to the routes and the football field.Football is a repetitive process. You hear things over and over and continue to do them in practice, then as time goes on you get better at those things.I think as time went on last season you saw guys—especially in the receiving corps—get more comfortable. They were better at catching the football, understanding the checks and changes that Eli was making at the line and adjusting to that.

B/R: For you especially, is it an offense that optimizes your skill set?Cruz: Absolutely. Week 6 is when I got hurt, and prior to that I had two 100-plus yard games already (107 receiving yards against the Houston Texans in Week 3, and then 108 yards in Week 4 during a win over theWashington Redskins). I was definitely still wrapping my head around the offense at that point, but I was doing fairly well in those games.I wanted to continue to do well and get better each week. I was getting more comfortable with the offense as the weeks went on. I think it’s definitely a system I can benefit from.B/R: Is going undrafted still a source of motivation for everything you do in the NFL, whether it’s learning a new offense or recovering from an injury?Cruz: It is every day. Each day I understand that I’m blessed to be in this position and where I am today after going undrafted. I chose a team that was the best fit for me, and at the time the Giants had a lot of proven receivers on their roster. I understood that but was able to overcome it.It definitely serves as my motivation to work hard every day. I have to continue that same undrafted-free-agent mentality to be better than I was before and to never be complacent. I think complacency is a negative in any sport and in any career for that matter.B/R: You went undrafted in 2010, and we’re deep into draft season now. The undrafted path presents difficult challenges and long odds. What’s your advice for prospects who aren’t drafted this year?Cruz: Do your homework. I remember when I was getting ready for the draft I wrote down every team’s receiving corps, keeping track of how many receivers they had, how many of them were entering contract years and how many were rookies.Do your homework on every team. Then if you go undrafted and have to make a decision in free agency, you can pick a team that has the fewest receivers and guys either in contract years or coming up to that point. That’s how you give yourself the best opportunity to play.And choose a team you feel has the best offense for you to showcase your talent. Sometimes it’s sort of a gift to go undrafted, because from whatever teams are interested you can pick wherever you want to go and wherever you have the best chance to get on the field.B/R: It sounds like you were very prepared for the possibility of going undrafted and had already done quite a bit of research.Cruz: I was a realist. I knew I wasn’t 6’3” or 6’4” with 4.29 speed (Cruz is 6’0”, weighs 204 pounds and ran the 40-yard dash in 4.51 seconds at his University of Massachusetts pro day). So I had to do the little things and show the effort and skills to make it to the next level.Cruz’s optimism about his recovery is echoed by Giants coaches and front-office executives. But they also speak with caution.“When a guy has a big injury like Victor had, you can’t put all your eggs in his basket,” said Giants general manager Jerry Reese to reporters at the NFL Scouting Combine.“Our doctors say he looks good. I see him down in the training room, working out with our trainers and our medical people, and he looks good. But his game is quickness. And until you get out there and move around, you never really know how he's going to recover from that."Though his progress is encouraging, uncertainty will hover over Cruz during the 2015 season and possibly beyond. Will he be able to cut abruptly, accelerate with short-area burst and generally be the same Victor Cruz who’s recorded 1,000-plus yards as a receiver twice over four seasons?We’ll know in five months. Meanwhile, Cruz will keep plowing ahead with that undrafted drive, just as he has throughout his entire career.Victor Cruz spoke with Bleacher Report while attending the Samsung Galaxy S6 launch party.

The Eagles made the surprising decision to trade Nick Foles to the Rams for Sam Bradford earlier this week. The deal itself is difficult to assess in the short-term; what isn't is Bradford's health.

We can debate until we're blue in the face whether the Philadelphia Eagles or the St. Louis Rams got the better of the Nick Foles-Sam Bradford trade.

In fact, any number of media pundits and talking heads are, as we speak, no doubt lying slumped over their keyboards, positively spent by their tireless need to declare a winner or put a letter grade on a trade that's less than a week old.

While the real results of the deal won't be known for months - and really, years, considering the time it takes for players to assimilate to new schemes and new teammates as well as the pending use of all of the oddly structured draft pick compensation involved - what is known is that for Philly, head coach Chip Kelly traded a steady, if athletically-limited winner in Foles for one of the formerly most talented and also most injury-prone quarterbacks in the NFL.

Kelly, the man who brought "sports science" to the NFL, is apparently so confident in his new-age methods for keeping players healthy that he believes he can take injury-prone guys from other teams - Bradford, DeMarco Murray, Ryan Mathews, Walter Thurmond - and help them via an increased focus on nutrition, altered training regimens, monitoring sleeping habits and yes, the milkshakes, to stay healthy as Philadelphia Eagles.

For a player like Bradford, who has now torn the ACL in his left knee twice, a high-risk factor for re-injury is presumably involved with his return to the field, but it may not be as unlikely for him to return to his Offensive Rookie of the Year form as previously assumed.

"A study published in Arthroscopy in 2005 found that 12% of patients re-injure their same knee or injure their other knee in the first five years following surgery," writes Justin Shaginaw, head athletic trainer for the US Soccer Federation. "Another study published in the British Journal of Sports Medicine 2006 found that soccer players with a previous ACL reconstruction had at least four times the risk of re-injury or injuring their other knee. Numerous research articles show continued deficits in strength and lower extremity control that can persist for years following ACL reconstruction. If you've followed ACL injuries in professional athletes, not everyone recovers as quickly as Adrian Peterson. Many end up like Derrick Rose and RG III."

Shaginaw reports that, statistically speaking, Bradford "is at high risk for re-injury," despite the fact that both of his ACL tears came as a result of contact mechanisms. Non-contact ACL injury mechanisms, per Shaginaw, could point to a pre-disposition.

Per Shaginaw, an article published in Orthopedics 2014 by Erickson, titled "Performance and Return-to-Sport After ACL Reconstruction in NFL Quarterbacks," looked closely at 13 NFL quarterbacks' performance after their return from ACL reconstruction.

"They concluded that there is a high rate of return to sport in the NFL for quarterbacks and that performance was not significantly different from pre-injury," Shaginaw writes.

It seems a predictive factor in a healthy return from ACL injury is where a player was selected in the draft - being selected in the first four rounds meant a high probability of return to previous playing levels - which makes sense considering players with greater levels of athleticism and overall ability, along with a particular mental makeup, tend to be taken higher.In the end, per Shaginaw, while there remains a likelihood of re-injury for Bradford and any patient following ACL reconstruction, quarterbacks, specifically ones taken high in the draft like Bradford, the former first-overall pick in the 2010 NFL Draft, tend to return to the field and, more importantly, perform well.

"NFL players in general show about a 63% return to play after ACL reconstruction. However, quarterbacks showed not only a high rate of return to play but a return to previous levels of performance."

What is happening inside Cliff Lee's elbow?

Dr. James Andrews’ phone call to the Phillies yesterday did not bring the good news for which they had hoped. Instead, it was confirmed that the tear in starting pitcher Cliff Lee’s common flexor tendon had not progressed since he left a game because of elbow discomfort back in July 2014.The injury has left Lee with few options, and the often grinning lefthander has even gone so far as to contemplate the end of his career. This is a man who has earned the devotion of fans, teammates, and coaches for his seemingly otherworldly endurance; however, it’s that same quality that has left his elbow ligaments straining to repair themselves.“It’s a pretty rare injury to have,” Justin Shaginaw, coordinator of sports medicine for Aria 3B Orthopaedics and athletic trainer for the U.S. Soccer Federation, says of Lee’s issue. “All the research shows most elbow pain in pitchers is [coming from] the ulnar collateral ligament, which requires Tommy John surgery.”But Tommy John is becoming a young man’s game, with more and more recipients of the procedure returning to play without issue. In fact, young starters such as Matt Harvey and Jose Fernandez, who missed 2014 after TJ surgery, probably benefitted from undergoing it now, rather than late in their careers when ligaments are far more worn down – in general, a younger pitcher’s body can take more surgery than the body of, say, Cliff Lee.

Lee, at 36 years old, isn’t throwing with a 20-year-old elbow anymore, and his injury is yet another indication of not only his advanced career but also his historically deep outings.“It’s an older pitcher’s injury,” Shaginaw explains, citing a study by Dr. David Altchek, the big name for Tommy John surgery up in New York, in which he compared eight players undergoing Tommy John and flexor tendon issues with players receiving solely Tommy John surgery. “The players with [Lee’s injury] were all 30 and above, where the common age for his Tommy John patients was 20.7 years, so it’s probably more of a wear-and-tear injury.”Many have theorized that Lee’s workhorse demeanor would eventually contribute to his health. Last year was the first time he didn’t surpass the 200 mark in innings pitched since 2009, and in 2010, he led the league in complete games. Nobody was complaining in April 2012, when Lee came back out of the dugout in San Francisco to throw a 10th shutout inning against the Giants (a performance in which he still threw only 102 pitches, 81 for strikes, and the Phillies wasted by losing in 11 innings).It has been Lee’s MO over the years – he’s a workhorse, a grinder, who always wants the ball – and while these are cited as valuable assets for a big-league pitcher, they also make it less likely that he will be able to return to the Phillies rotation in the present. In Altchek’s study, players with flexor tendon problems rarely came back from surgery; however, some of that was due to their being over 30 years old, which always results in lower return rates.The theory is that in cases like Lee's injury, they are indicative of one ligament attempting to compensate for stress on another, Shaginaw explains. "In these cases, the ligament is already stretched or loose, but not completely torn. The muscle is trying to stabilize the elbow due to the laxity/looseness in the Tommy John ligament. Over time, the muscle is injured because of it trying to do the work of the Tommy John ligament."This is something the Phillies in all likelihood know and have tried desperately to smooth over in the past few months. Things must be pretty messy inside Lee’s elbow, however, if months of recovery time can pass, yet it only takes two innings to unravel his season.“Knowing [Phillies head trainer Scott Sheridan] and the Phillies well, I’m making the assumption that they’ve done their job as far as rehab’s concerned and that they’ve fixed everything that they can fix from a biomechanical standpoint,” Shaginaw says, but if Lee is still experiencing discomfort, then Shaginaw concludes, “I can’t see him getting better with continued rehab.”It has been the same non-surgical rehab that Ruben Amaro says hasn’t worked, leading to surgery as the next option – not ideal for a pitcher in his late 30s. The Phillies are clearly not prepared to throw in the towel on their $25 million investment for 2015, saying that Lee could attempt to “throw through” the issue, a plan that sounds slightly hazardous.Shaginaw stipulates that “throwing through it” is not a recommended remedy at every stage of the game – “If he were in his 20s, they would have done the surgery already.” But in Lee’s case, all you can do – as Lee often does – is shrug.“I think their thought process is at this point, you might as well let him throw through it,” Shaginaw theorizes. “And if he can’t throw through it and he wants to continue to play, they’re going to do the surgery with the expectation of probably pretty low chance of returning to the same level.”

Scarring a concern with common flexor tendon injury

The Phillies recently announced that pitcher Cliff Lee is still working through the common flexor tendon tear that limited his play last season. Depending on his throwing progression, his doctors will have to decide what the next steps will be. Why is this injury such a concern for baseball players?The common flexor tendon is on the inner side of the elbow and is the major attachment for the muscles in the forearm and wrist. It helps control movement in the hand. Injury can occur with overuse of both the muscles and the tendons. Usually conservative treatment is rehabilitation and rest, but more critical cases might need surgery.According to Dr. Thomas Trojian of Drexel Sports Medicine, “Recovery usually is 6 to 12 weeks, but with muscle injury it could be longer,” he explained. “When muscles tear, they scar easily, which can lead to more muscle injury.”“Often it depends on how bad the muscle is torn. If it is torn off the bone, then it can simply be reattached, but if the tear is closer to the hand, surgery does not do as well,” he said.When it comes to treatment and recovery, Trojian emphasized the importance of muscle retraining.According to Justin Shaginaw of Aria 3B Orthopaedic Institute, often a full kinetic chain analysis will be done. He explained that “the kinetic chain starts at the foot and goes all the way up to the hand, and any problems within the chain could affect performance.”He added, “There is a difference between recovery and full play. Velocity and control of pitch matter when it comes to whether or not a player can return to play.”

Are NFL Athletes Playing a Dangerous Game with Too-Fast ACL Returns?

On Dec. 24, 2011, Adrian Peterson picked up a dusty, dog-eared book. "How to Recover from a Torn Anterior Cruciate Ligament," the cover read. He flipped through the first few pages, shook his head and set the thing on fire.

The Minnesota Vikings tailback grabbed a pen of grit and sweat and seemingly superhuman healing powers, sat down and re-wrote the book on ACL rehab. In five months, he was working out, shuttling and jumping and bursting. In eight months, he was at full speed.

On Sept. 9, 2012, Peterson launched a 2,097-yard, 12-touchdown assault on the NFL, carrying his Vikings to the playoffs and earning The Associated Press' NFL MVP award.

Now, every NFL player who suffers the same injury picks up the book Peterson wrote. Each one flips to the back, reads the fairy-tale ending and sets off down the same yellow brick road. Unfortunately for non-superhumans, coming back better than ever in eight months is unrealistic—and may be unwise.

Decades ago, ACL injuries were poorly understood, and reconstruction surgeries were poorly executed. As Justin Shaginaw, ATC, and Arthur Bartolozzi, M.D., wrote for Philly.com, the crude surgery and insufficient rehab often ended careers.

In the 1980s and 1990s, the advent of arthroscopic surgery and improved rehab techniques enabled players to return much faster, for better or worse.

A 2002 study in Arthroscopy: The Journal of Arthroscopic and Related Surgery looked at ACL injuries in the NFL from 1994 to 1998. The data came from surveys of every NFL team's trainer. For players with no swelling, typical range of motion and sufficient strength, 90 percent of doctors allowed them back on the field in six months.

Even that wasn't fast enough for Hall of Fame receiver Jerry Rice. He shocked the football-watching world in 1997 when he blew his ACL in Week 1 and got back on the field in Week 15.

Rice's rehab was nowhere near complete, though. In 2012, he told NFL Live the cracked patella he suffered in that game was due to his hasty return, per Michael David Smith of Pro Football Talk: "I feel that I rushed myself back to the football field. And I think that with Adrian Peterson, he’s doing the same thing. Because we are accustomed to being out there with the guys, sweating with the guys, fighting on the football field. And if you’re not able to do that you just don’t feel connected. And that’s the reason why I rushed back. I hope he doesn't do the same thing."

This was simply too fast. Rice wasn't breaking the mold; he was just breaking the rules. At the time, other athletes thought they could pull off similar turnarounds.

Dr. Christopher Harner, president of the American Orthopedic Society for Sports Medicine, told USA Today's Gary Mihoces this was doomed to fail.

"In the early 2000s, there were a lot of people pushing—without any science—returning in like 2-4 months," Harner said. "Many of these athletes weren't ready. They didn't have the muscle power. They didn't have the balance...their knee would fatigue, and they'd blow the graft out again."

Today's quick, complete returns aren't fueled by patients who ignore doctors' orders, such as Rice, but advances in treatment, surgical techniques and rehab.

Dr. David Chao, a former NFL trainer with 17 years of experience and current columnist for the National Football Post, did a long-running series tracking the ACL rehabs of Denver Broncos linebacker Von Miller and New England Patriots tight end Rob Gronkowski. In that series, he explained exactly how today's treatments facilitate better, faster return to play.

One therapeutic advance has been extended "prehab," range-of-motion rehab before surgery and an extended wait before performing the reconstruction. This lets swelling go down and allows the knee to retain as much of its pre-surgery flexibility as possible.

In the mid-1990s Arthroscopy study, 90 percent of surgeries were done two weeks post-injury, 3 percent were done three weeks after, and 3 percent were done just one week after injury. As Dr. Chao wrote, Miller's surgery came after two-and-a-half weeks of prehab, and Gronkowski's surgery came more than a month post-injury.

"A chronically stiff and swollen knee is among the worst outcomes from ACL surgery and should be avoided at all cost," he wrote. The long pre-surgery waits for Miller and Gronkowski "were meant to speed their recovery and return to play, not delay it."

The surgery itself is largely similar over the past two decades. Over 81 percent of mid-1990s ACL reconstructions used a patellar tendon graft. That's the overwhelmingly preferred choice today, too, per Dr. Harner.

"Putting [the graft] in the right spot, using the athlete's own tissue and returning them cautiously with correct rehab. Those are the three keys," said Harner, who called the athlete's own patellar tendon or hamstring tendon the optimal graft. Synthetic replacements and cadaver tendons have been tried, but Harner thinks "your own tissue is better."

Dr. Chao notes many reconstructions now include an innovation called a "notchplasty," which gives the graft more room to grow and reduces the risk of tearing.

Rehab starts post-surgery. The standard R.I.C.E. treatment (rest, ice, compression and elevation) for soft-tissue injuries is still important, but the rehabbing athlete will utilize a continuous passive motion machine to help regain range of motion, as well as ice machines and anti-inflammatories: "I give my patients four practical goals to reach by the end of week 2. First, we want to get their knee completely straight. Second, we want to perform a straight leg raise. After that we want to progress off crutches and slowly walk normally (heel-toe gait) without a limp. Finally, the last goal is to gently pedal a full revolution on an exercise bike."

If the athlete can hit all four of those goals within two weeks of the operation, Dr. Chao wrote, he's in the 90th-plus percentile of all recoveries and well on his way to a fast turnaround.

Weeks four and five focus on strength, using foot-planted exercises such as squats and lunges that don't strain the graft. At week six, Dr. Chao's on-track patients may run short distances in a straight line. "I prefer that a patient jog for 500 yards with normal stride and no limp rather than someone who runs five miles while limping the entire way," he wrote.

After three months, patients still on the fast track may return to on-field drill work. Dr. Chao recommends an ACL brace be worn at this point. Peterson can be seen wearing one in the video above.

It's at this point that athletes seem deceptively close to complete recovery. Rice went out and played in a game (and cracked his patella). In 2008, San Diego Chargers quarterback Philip Rivers participated in minicamp 100 days after surgery. In 2014, soon-to-be Tennessee Titans quarterback Zach Mettenberger threw at his pro day.

Many of the athletes who suffered ACL injuries during the 2014 season are at this point in their recovery right now. Detroit Lions linebacker Stephen Tulloch posted this Instagram video of himself doing on-field drills at four months post-op:

For all the prehab and rehab, though, Tulloch's knee isn't healed. The ligament needs to regrow along the graft, which Dr. Chao describes as a "scaffold." Tissue, blood vessels and nerves need to form. No amount of grit or effort can speed that up. "The process of turning any tendon graft into a ligament takes a minimum of 18 months," Dr. Chao wrote. Though Peterson was running wild through NFL defenses in 2012, his reconstructed ACL was nowhere near healed. In fact, even as he was bursting through linebackers and racing past safeties, his recovering knee still wasn't performing at pre-injury levels.

Researchers found no difference in performance between healthy and rehabbing athletes in two-legged tasks such as running and jumping but found significant deficits in reconstructed knees in one-legged tests. Despite an apparent return to full performance, the ligament still isn't fully healed—and isn't out of the danger zone for re-injury.

Unfortunately, per Dr. Chao, chances for full-performance recovery drop "significantly" after a repeat ACL rupture. One of the primary reasons: The patellar tendon has already been used as a graft donor, so his surgeon will likely have to use a different tendon or source a cadaver gift.

Even without a re-injury, players such as Gronkowski, with multiple ligament tears and/or cartilage damage, often have an even longer wait between being cleared for full-speed play and truly reaching pre-injury performance.

Gronkowski's Pro Football Focus grades back this up: He had only two positively rated games in the first five weeks of the season but only one negatively graded game the rest of the year. Despite the slow start, he finished the season as PFF's highest-graded tight end.

At 13 months post-surgery and beyond, the ligament's re-growth is well along. Once the "ligamentization" process is complete, per Dr. Chao, the reconstructed ACL is as little as half as likely to rupture as the other knee's healthy ACL!

"Early return has become the industry standard," wrote Dr. Chao. "In a perfect world, an athlete would sit out two seasons before playing, but this is simply not practical."

Peterson's super-fast return has given other athletes false hope that getting back on the field is simply a situation of mind over matter."I’m just trying to cut the time in half," Arizona Cardinals defensive lineman Darnell Dockett told the team's official site a little over a week after his late-August ACL reconstruction. "Adrian Peterson did it and came back and led the league in rushing. I just try and look at the whole situation. If there are ways I can cut corners by going four times a day I’ll do that. It doesn’t exactly come easy."No, it doesn't, especially since Dockett had an MCL tear, too. At the time of this writing, Rotoworld lists Dockett as "questionable for OTAs." OTAs typically occur in late May, which would be nine full months after Dockett's surgery. That would be fast indeed for a multi-ligament rupture but hardly cutting the time in half.I compiled 27 ACL injuries in 2014 among NFL players with a verifiable return timetable and secure roster spot. The average of their projected post-op return time: just under 10 months. With all the modern innovations in pre-surgery treatment, reconstruction and rehab, most players' knees still aren't strong enough for a safe return to play until at least nine months out.

Peterson's still the exception, not the new rule.Players with clean ACL ruptures, no other torn ligaments, no collateral damage and low positional requirements for reactive cutting can push the timetable; Cardinals quarterback Carson Palmer told ESPN's Ed Werder he'll be ready for May OTAs after his November surgery.However, unless the 35-year-old wants to risk a Bradford-style re-injury—and the remainder of his career—he'll do the smart thing and sit out until training camp.

MEDICAL EXPERTS' TAKE ON FOLES', RYANS' INJURIES

We don't know the results of the MRIs yet for Nick Foles and DeMeco Ryans, but in the meantime, Action News spoke with a few sports medicine experts. They are not treating the players, but offer their take on the injuries and how long they may take to heal. Dr. Arthur Bartolozzi and physical therapist Justin Shaginaw with Aria 3B Orthopaedic Institute watched replays of Foles' and Ryans' injuries.

Eagles coach Chip Kelly said Monday Foles suffered a cracked collarbone. Dr. Bartolozzi explains if the clavicle is completely broken and displaced, that means surgery and an average 8 to 9 weeks recovery. But what if it's less severe? "If it's a little crack, then a sling and it will heal in about 4 to 6 weeks," Dr. Bartolozzi said.

As for Ryans, he's said to have a right Achilles injury. The MRI will give more details. But Dr. Bartolozzi says most Achilles tendon injuries are a complete tear. "It's usually a snap," Dr. Bartolozzi said. That requires surgery. "Often it looks like a bunch of fibers, we sow all the fibers together carefully, and then close it up, and keep the foot in a position where it's relaxing the tendon," Dr. Bartolozzi said. Justin knows firsthand what that's like. This past July he tore his left Achilles tendon. In the past, he tore his right. Ryans also has a history of tearing his other Achilles tendon. Justin can imagine what went through the linebacker's mind. "You know what happened, but you don't really want to admit it and you just know the long recovery and rehab that you're in for," Shaginaw said. "It's unlikely he'll be back this year," Dr. Bartolozzi said. If the Achilles tendon is completely torn, after surgery it takes 6 to 8 weeks before someone can put their full weight on that leg. And it takes much longer before they'll be able to run or jump on it.

Again, MRIs were done Monday on both players. There is no word yet on when the Eagles will release the results.

Dr. William Meyers, who did the surgery to repair the center's sports hernia, has said that he's had patients come back in 3 to 6 weeks.

"I would think that's probably a reasonable time," said Dr. Arthur Bartolozzi, who is director of sports medicine for Aria 3B Orthopaedic Institute. "But I would go with a longer [return] than a shorter [one]. That gives the player some time to fully recover, feel comfortable and get back to the ability to perform ballistic activities."

Dr. Ulrike Musthaweck, a German surgeon, has performed a less invasives ports hernia surgery on dozens of professional soccer players over the last decade and has had them back on the field in as little as a week to 10 days. Justin Shaginaw, who is the lead therapist/coordinator of sports medicine at Aria 3B and served as an athletic trainer for the U.S. World Cup team, said Michael Owen, a former player for England, had sports hernia surgery done by Musthaweck a week or 2 before the 2006 World Cup and returned in time to play."There was another player who had it done about 3 weeks before the 2010 World Cup," Shaginaw said. "There is less trauma with her surgery. So, in theory, players can come back a little sooner than they can with Dr. Meyers."

Many MLS players with sports hernia injuries have flown to Europe and had them repaired by Musthaweck. NFL players have yet to follow suit.

Funds secured for artificial turf field at high school

Matt Leidemer

The Plainview CitizenBy Adam StuhlmanPublished: August 5, 2014

According to a press release from State Rep. Betty Boukus’ Hartford office, Plainville will receive $950,000 to construct a new synthetic turf field at Plainville High School. The state grant will fund the replacement of the natural grass field within the high school football stadium with a safer and more durable synthetic turf field, the release stated.﻿Plainville Superintendent of Schools Jeffrey Kitching said that while Boukus, who represents the 22nd District, received approval from the State Bond Commission on July 25, the Board of Education would still have to vote on the matter.

“If and how we do this, I don’t think this would require a vote from the citizens, but it would require a vote from the Board of Education,” Kitching told The Citizen. “The board will need to take action around September, October, and the work would probably start late next spring.”Plainville Town Manager Robert E. Lee said he feels there is more than one benefit to switching to artificial turf. Both he and Kitching said that artificial turf is cost-effective.“Studies show that students are less likely to get injured on turf,” Lee said. “It would also increase the usage of the field for, not only the school, but recreational use as well.”Kitching said artificial turf would have less maintenance costs than grass. He cites irrigation and drainage of grass as ongoing expenses. Artificial turf is “safer and far more durable,” the superintendent said.Kitching said the quality and safety of turf fields has improved in a short time frame, and that this makes the BOE more comfortable with the potential change.The ongoing argument in athletics between artificial turf and natural grass mainly surrounds injuries. Studies on both sides support the use of turf and the use of grass.According to his blog, philly.com, Justin Shaginaw is an athletic trainer for the U.S. Soccer Federation and a member of the Aria 3b Orthopaedic Institute.“Research has shown that as the coefficient of friction increases there is an increase in the rate of lower extremity injuries. This means that the more traction you get on the field or court, the higher the risk of injury. The common thought is that turf has more traction than grass and therefore we will see more injuries on turf,” Shaginaw wrote.Shaginaw cites multiple studies he says were from 2010-2013 that provide arguments on both sides of the debate.“A study published in 2011 looking at football, rugby, and soccer injuries showed that there was a higher incidence of ankle injuries on artificial turf. In 2012, another study looking at NCAA football injuries showed an increased risk of ACL injuries on artificial turf. Lastly, a 2013 study looking at amateur soccer players in Portugal showed a greater rate of lower extremity injuries on turf during matches vs. training,” he wrote.However, there are studies supporting the use of various forms of artificial turf, such as FieldTurf, according to Shaginaw. He wrote: “A 2010 study looking at collegiate football injuries showed that FieldTurf may actually be safer than natural grass for injuries in general. This study also found no significant difference in knee injuries between surfaces. Another study in 2013 looked at injury rates between grass and artificial turf in female collegiate soccer players. This study actually showed a significantly lower total injury incidence rate and a lower rate of substantial injuries on FieldTurf. This study also showed no significant difference in knee injury rates between the two surfaces.”Perhaps it depends on the type of turf and the athletic shoes used, as Shaginaw wrote that cleats designed specifically for artificial turf – or even turf shoes – can help to reduce the risk of injury.

USMNT injuries and what they mean for the rest of the World CupPhilly.com Sports DocRobert Senior, Event coverage, Sports Doc contributorPOSTED: TUESDAY, JUNE 17, 2014, 5:21 PM

United States' Jozy Altidore grimaces after pulling up injured during the group G World Cup soccer match between Ghana and the United States at the Arena das Dunas in Natal, Brazil, Monday, June 16, 2014. (AP Photo/Dolores Ochoa)

One of the biggest victories in recent United States soccer history did not come without a price.Last evening’s match with Ghana saw United States Men’s National Team (USMNT) striker Jozy Altidore leave the game with what appeared to be a significant hamstring injury. In interviews, Altidore described the injury as ‘the worst feeling’ and said he was “crushed”—emotions not typically associated with a quick return to action.Later in the game, USMNT center back Matt Besler left the game with a hamstring injury of his own. While Besler’s injury did not appear to be as serious, he was unable to continue after halftime, leaving his status for the game against Portugal this Sunday in doubt.“Comparing the two, [Altidore] pulled up in the middle of the field, whereas Besler sort of grabbed his hamstring and kept playing,” says Justin Shaginaw, M.P.T., A.T.C., who works with US Soccer and traveled to the 2010 World Cup with the USMNT. “That’s not always a true indication of severity, but if it is a serious injury, you’re looking at a 3-6 week recovery.”

The MRI results for both players will likely be available later today. Clint Dempsey, who scored the USMNT’s first goal seconds into the match, broke his nose later in the game. The injury is unlikely to keep Dempsey out of action; but could potentially affect him in the humid climate Sunday.“If they need to re-set the nose, the swelling and occlusion are things that can affect his performance to a degree,” says Shaginaw. “But I expect he’ll play through the injury.”Of particular note was the comment by ESPN’s Taylor Twellman, who said last night’s match was the first time he remembered seeing a United States team that didn’t look fit. If the Americans are known for one thing in world soccer, it’s top-of-the-line fitness. Is there anything to Twellman’s observation?“There are two main reasons why muscle injuries occur,” observes Shaginaw. “One is being out of shape, and the other is fatigue from being overworked.”“But there is a third factor, and that’s plain old bad luck.”When two starting players sustain similar injuries in the first half of the first game, there’s definitely an element of misfortune. Sunday’s match in Manaus—located right in the middle of the Amazon rainforest—will be the most physically demanding of the entire tournament for the USMNT, and will tell us once and for all just how prepared this team is.

Justin Shaginaw, MPT, ATC, (left) and Jim Bollinger, ATC, CSCS, worked as members of the US Soccer athletic training staff at the 2010 World Cup in South Africa. (photo/courtesy Justin Shaginaw)

Every four years, the attention of the world turns to the sporting event watched more than all others -- the World Cup. Fortunately 2014 is such a year, with the global soccer showcase descending on Brazil from June 12-July 13. The last time soccer's signature event was held there in 1950, a lightly regarded US men's national team sprung one of the greatest upsets in World Cup history, besting tournament favorite England in the opening round. Alas following that watershed moment, the US team failed to qualify for any World Cup during the next four decades. But the past 25 years represent a golden era in American soccer as the team has earned seven consecutive World Cup berths, from the 1990 tournament in Italy through this year's event in Brazil. Highlights during that time include hosting the 1994 World Cup and achieving a best-ever finish in 2002 by reaching the quarterfinals in South Korea. At the most recent World Cup (2010 in South Africa), the US recorded another milestone, winning its opening-round group for the first time before falling in the Round of 16. Now, the team finds itself among 32 that will take the field in Brazil, with the eyes of the world upon them and hopes of a championship in their hearts. The road will not be easy, however, as the scheduling draw did the US no favors. It has been assigned to a so-called "Group of Death" in the opening round, featuring opponents Germany (#2 in the world), Portugal (#3 in the world) and Ghana (#38 in the world, but a quarterfinalist in 2010 and the country that eliminated America from the past two World Cups). The US, meanwhile, is ranked a solid #14 by FIFA (Federation Internationale de Football Association), but seen as a definite underdog in its group since only two of the four teams can advance to the Round of 16.Unforgettable ExperienceIvan Pierra, MS, ATC, CSCS, US Soccer men's national team head athletic trainer, knows all about the excitement and intensity of the World Cup. He has already experienced three of them firsthand and will be on the sidelines with the team in Brazil this month. "Brazil lives and breathes soccer," he told ADVANCE. "Their culture is soccer. So to be part of a World Cup there is going to be an experience like no other! I'm most looking forward to the atmosphere itself and our competition. The World Cup is a very intense and challenging experience as an ATC." Pierra originally became involved with US Soccer in 1994, when he was invited by the team's head athletic trainer at the time, Andrew "Rudy" Rudawsky, MS, PT, ATC, to be a volunteer ATC for that year's World Cup team. He continued to work with the squad on a game-to-game basis, while also becoming head athletic trainer of the Los Angeles Galaxy in Major League Soccer when that team started play in 1996. Eventually, US Soccer would hire Pierra in 2007 to be its own head athletic trainer. "As head trainer, I oversee all the medical operations of the men's national team," Pierra explained. "That includes monitoring everyone in our player pool on a daily basis while we're not playing and keeping our equipment ready for each camp."Justin Shaginaw, MPT, ATC, has significant experience as a rehab professional with US Soccer as well. While working full-time as lead therapist and coordinator of sports medicine at Aria 3B Orthopaedic Institute in Philadelphia, Shaginaw is also part of the athletic training staff for US Soccer and accompanied the men's national team to South Africa for the 2010 World Cup. He initially joined the organization in 2007 with the under-16 girls' team and by 2008 received his first invitation to work with the men's national team. In the years since, Shaginaw has crisscrossed the hemisphere while traveling with the team, particularly for World Cup qualifiers between the US and other teams in its region of CONCACAF (Confederation of North, Central American and Caribbean Association Football). "I've been all over the Caribbean with the team, as well as numerous domestic matches," Shaginaw explained. "I've also traveled to Sweden and Poland for friendlies and of course South Africa for the World Cup." Shaginaw's World Cup experience was exhilarating but definitely work-intensive. "We were there about a month and I think in that time [the athletic training staff] had one full day off," he related. "The players do get free time, where they might take a trip to the mall or play golf in the afternoon, but some of us would still need to be available for them. So we'd try to arrange it on a given day where two of us could go somewhere just to get away for a little while and the other two stayed around. But we were pretty much on-call 24 hours a day. So it's not always filled with glory, but I can say it was very exciting to be on that field when we played England [in the first match]."Dual RoleOne of the reasons traveling with the team can entail such a busy workload is because of the multilayered responsibilities, related Shaginaw. "We're athletic trainers dealing with injuries, but we're also the massage therapists on the trip. So there are generally two different groups of players. The healthy guys who just need some maintenance like massage, soft-tissue work and stretching, then the injured players who have more of a rehabilitation status." So what are some of the typical injuries Shaginaw will encounter among soccer players? "Definitely hamstring strains, MCL sprains, hip problems and sports hernias. Ankle sprains are fairly common, along with blisters and toenail injuries. Concussions have been infrequent in my experience, but when they occur can be pretty serious injuries." Pierra also mentioned the predominance of lower-body injuries, from foot and ankle sprains to thigh and hip strains. "The most challenging aspect of my job is managing the players' health throughout our camps," he noted. "I'll typically put in 18-hour days when we're in camp. But the most enjoyable part is the different relationships and friendships that are built with staff and players, as well as the excitement of competition at the highest level. South Africa in 2010 was my third World Cup and felt just as amazing as my first!" Now all attention turns to Brazil, which has won the most World Cups (five) in history. For a month, the greatest soccer players on Earth will battle to determine a new champion, as hundreds of thousands watch in stadiums and hundreds of millions stand captivated around the globe. World No. 1 Spain seeks to defend its 2010 title while the host country fights to protect its home turf and mount a record-setting sixth trophy on the mantel.Meanwhile, 30 other teams look to make their own mark on the tournament, including the Stars and Stripes now firmly established as a player on the world scene. After four long years of waiting, first kick is just days away -- are you ready?Brian W. Ferrie is on staff at ADVANCE. Contact: bferrie@advanceweb.com

A sadly familiar and always unwelcome sight greeted the Phillies during A.J. Burnett's last start - a solemn pitcher leaving the mound with a trainer bowing his head. It was later announced that the hurler was suffering from a sports hernia, but, despite suspicions, Burnett will pitch his next start.

The 37-year-old is averaging a bit over five innings per start, keeping his ERA a hair under 4.00, and leads the league with 14 walks. He has not been the most effective starter in a rotation aching for the return of Cole Hamels. So, how smart of a move is it for Burnett to throw with a hernia inside of him?

"An inguinal hernia is what you think of as a hernia," said Justin Shaginaw (MPT, ATC), an athletic trainer with Aria 3B Orthopaedic Institute. "You have a protrusion on your abdomen where it's an inguinal ring where your - for lack of a better term - your inside bulges out; versus a sports hernia, which can be all kinds of different things. It's usually when an abdominal muscle and the abductor muscle attach onto the pelvic bone."

Surgery is in Burnett's future, but his current condition is one that he - and most others with it - should be able to pitch through. "It's just about whether it bothers him enough and whether or not he decides to get it fixed," Shaginaw said.For an older pitcher with injuries in his past, Burnett may find himself in that position. As a pitcher, the slightest alteration to his delivery could shave five miles per hour off his heater.

Scott Rice of the 2013 Mets pitched with a secret hernia until September 6, amounting an ERA of 3.71 in 73 games. Manager Terry Collins was in the loop about it and explained that it wasn't until Rice complained of intensified pain that he was made unavailable.

Collins said Rice had received treatment "each and every day," and initially thought that Rice might be suffering from an unrelated hip strain. But in the end, Rice's season ended early with surgery.

The lefty, now 32, recovered and is part of the Mets bullpen again this year, appearing in four games thus far and giving up four runs over 2.2 innings for a 13.50 ERA.

Rice's example aside, Burnett now has a season ahead of him in which daily responses to the current condition of his hernia will be likely.

"You do whatever you can," Shaginaw said. "You try to do some flexibility and strengthening, treat it with medicine or ice or cortisone injections. It doesn't really worsen, it just gets more symptomatic. You can wait forever to get it fixed. It's just about how painful it is."

For a team that was granted quickly thinning pitching depth by Burnett's arrival, this is an unwelcome, if manageable, development for the Phillies﻿.

PHILADELPHIA, PA.; Febuary 4, 2014 --Not all snow is light and fluffy. In fact, the dense snow we got yesterday and are expecting more of tonight can actually be pretty heavy.To find out just how heavy, photographer Jason Marraccini and I shoveled and filled this bin to the top with snow.We cleared about 15 feet of a sidewalk in Fishtown.Then at Penn Treaty Metals, we put it on the scale.Altogether: 427 pounds. Take off 84 for the weight of the bin, and our snow pile weighed 343 pounds!That's a lot of lifting, which is why physical therapist Justin Shaginaw, M.P.T., of Aria 3B Orthopaedic Institute says proper body mechanics is vital."What most people do wrong is sort of bend at the waist, forward and then twist and throw," says Shaginaw.He says that can easily lead to back sprains and strains.Instead keep your back tall, bend with your knees and move your feet to turn and dump snow.Also, if possible, try to just push the snow."So you don't want to lift, lift as little as possible," says Shaginaw.Also a smaller shovel, or fill just a quarter or half of a larger one. It may take you longer but it will help save your back.Shaginaw also recommends treating shoveling like a workout.: warm up before, and drink lots of water during the chore.But if you have any heart problems. It's best to ask someone else do the shoveling."There is a lot of stress involved. It's uncommon but we've all heard of the person who's had a heart attack while outside shoveling snow," says ShaginawThe National Safety Council goes further, even recommending anyone with heart problems get a doctor's OK before lifting a shovel.Also, according to the NSC, you shouldn't shovel after eating or while smoking. Those also put too much strain on the heart.And listen to your body. If you have any chest pain or shortness of breath, you need to stop shoveling and get to hospital.For the National Safety Council's full list of tips: Shoveling Safely.For more on Aria 3B Orthopaedic Institute, click here..

“It’s happening again!”That was the initial reaction of many 76ers fans, as news broke that the team was trading All-Star point guard Jrue Holiday to the New Orleans Pelicans as part of a package that would bring back much-heralded draft pick Nerlens Noel from the University of Kentucky.Why the concerns? Well, Noel is currently recovering from an ACL tear that is expected to keep him out until December. After the previous year’s drama with Andrew Bynum, how could the Sixers deal their potential franchise player for another injured big man?For one, the two situations couldn’t be any more different. “What Noel has is a straight-forward ACL tear,” saysJustin Shaginaw, MPT, ATC, coordinator of sports medicine at Aria 3B Orthopaedic Institute. They take 9-12 months to heal, and then he should be back on the court. The rest will depend on his talent and maturity.”

Noel, who will likely make his NBA debut at the tender age of 19 (he turns 20 on April 10) also has the benefit of no significant injury history before the ACL tear. Bynum’s injury problems were often attributed to the cumulative effect of repeated knee injuries throughout his career.Noel’s ACL surgery was performed by the famed Dr. James Andrews, and he is rehabbing with Kevin Wilk, P.T., D.P.T., whom Shaginaw calls “one of the best physical therapists in the country.”Noel stands almost 7 feet tall, but weighed only 216 lbs. before the NBA Draft. Shaginaw says his size shouldn’t have any impact on the recovery from injury. “If anything, his lower weight will lead to less stress on the knee,” he explains.In summary, the success of this trade will be determined on the basketball court—not in the trainer’s room.

When will we see Utley back on the field?Robert Senior, Event coverage, Sports Doc contributor Posted: Friday, May 24, 2013, 11:44 AM

Last night, the Phillies confirmed what most fans have suspected all week—Chase Utley is indeed heading to the 15-day DL with a mild oblique strain.The organization quickly stated that the expect the second baseman back after those 15 days—yet on this morning’s television broadcasts, reports indicated Utley could be out for “up to four weeks.”Research in the January 2012 edition of the American Journal of Sports Medicine looked at Major League Baseball players with oblique strains from 1991-2010. The research, led by Los Angeles Dodgers director of medical services guru Stan Conte, PT, DPT, ATC did not differentiate between first-degree, or mild strains (which Utley has) and second/third-degree strains. It did, however, provide some specific based on player positions and other variables.

The average time missed for players with oblique strains from 1991-2010 was 30 days.

Position players (non-pitchers) missed an average of 26 days during this time

Among position players, switch-hitters tended to miss longer than 26 days on average.

Utley, a strictly left-handed hitting second baseman, falls directly into that first group of position players with the 26-day average. But when taking into account that his strain is admittedly mild—and that the aforementioned research includes strains of all different severities—that 15-day timeline sounds a little more realistic.“It’s absolutely realistic that Utley could be back in 15 days,” said Sports Doc’s Justin Shaginaw, MPT, ATC. “In a long season like MLB’s it just doesn’t make sense to take any chances—because he won’t hit well for as long as this injury lingers.”

Wednesday’s press conference confirmed some of our worst fears when Roy Halladay announced he would undergo arthroscopic surgery to address a partially torn rotator cuff and a fraying labrum in his right shoulder.Uncertainty was the theme of the press conference, as Halladay shared that doctors are optimistic he can return to pitching later this season. Later, however, he admitted that doctors could find more extensive damage once they are able to see the shoulder during surgery.Sports Doc went in search of some hints as to the most likely outcome for Halladay in 2013—and beyond. The key may be the bone spur in Halladay’s shoulder that is causing the fraying of the labrum.“It’s not the surgery that will allow him to get better—if he gets better,” says Justin Shaginaw, MPT, ATC, lead therapist and coordinator for Sports Medicine at Aria 3B Orthopaedic Institute. “He would improve because the 3-4 months he spends on the disabled list would allow him time to rehabilitate correctly.”

Shaginaw cautions, however, that Halladay’s specific injuries are more than likely the result of long-term wear and tear due to kinetic chain issues over several years.“If he has a bone spur, then this has been going on for a long time,” he adds. “And if the results of the MRI have progressed from last year, that’s obviously not a good thing.”The fraying of the labrum means it’s slowly wearing out, as opposed to a tear which would indicate an acute injury. “Again, this has apparently been going on for a while. It just finally reached the tipping point.”Halladay’s sparkling career record and history overshadow the fact that is at least his 4th career trip to the disabled list due to shoulder issues—and the second such occurrence in the past 12 months. From this point forward, it will be safe to say he has a history of shoulder problems. Even with proper rehab, what are the odds that a 36-year old pitcher will be able to fix those underlying issues and put these problems behind him?“He’s got three problems—the rotator cuff, the labrum and the bone spur. Those are all long-term issues, which means that the issues along the kinetic chain are pretty well engrained by now.”The return-to-play rates of MLB pitchers following rotator cuff surgery are inconclusive—for every success story like Jimmy Key, there’s a sad, career-ending tale of a Mike Scott. It’s safe to say, however, that the Phillies’ ace faces an uphill climb to become the Roy Halladay of old.“That’s the hardest thing about this,” admits Shaginaw. “I’ve seen people with terrible knees who get scoped, and you think they’re not going to get any better. But sure enough, they’re back out there playing at the same level they did before the injury. You just never know.” So in the end, even the medical community can’t conclusively answer whether data and evidence will outweigh the will of a Hall of Fame-caliber pitcher. The likeliest outcome, as always, lies somewhere in that grey area.“I think [Halladay] can return to baseball,” Shaginaw concludes. “But I don’t expect we’ll see the same Doc Halladay we all recognize.”

If there was any doubt remaining, it’s gone today—Phillies fans have pressed the panic button in regards to Roy Halladay’s 2013 season.The latest setback, a 2-plus inning outing that yielded nine runs to the lowly Marlins, was just the start of yesterday’s disappointment. After the game, Halladay told reporters that he’d been experiencing discomfort in his right shoulder—an announcement that came as a surprise even to Phillies general manager Ruben Amaro Jr.It’s not known how long Halladay will be on the shelf. Amaro has already admitted the pitcher is almost certainly headed to the disabled list—but is there any chance Halladay will be ready to return 15 days from now?“Anything’s possible,” said Justin Shaginaw, MPT, ATC, lead therapist and coordinator for Sports Medicine at Aria 3B Orthopaedic Institute. “This could be a muscle strain, something where he slept wrong—it doesn’t have to be a worst-case scenario.”

Shaginaw quickly added, however, that such a outcome is rather optimistic at this point. Next he discussed worst-case scenarios, which are as follows:

Labral tear

Rotator cuff tear

A combination of the two

Such a result would mean the end of Halladay’s 2013 season, and potentially his time as a Phillie (the team has a $20M option on his contract for 2014, one they are extremely unlikely to pick up if Halladay is coming off major surgery.)The middle-of-the-road, perhaps likely, scenario involves an injury that wouldn’t necessarily require surgery, but nonetheless would result in an extended DL stay. “All pitchers acquire kinetic chain problems... say, an issue where the big toe isn’t providing enough push off of the mound, which causes the pitcher to drop his shoulder,” said Shaginaw.The training staff would need to do a thorough evaluation and see where any supposed deficits might lie before returning Halladay to a throwing program—usually a 6-8 week proposition.Of course, the elephant in the room is the age question. Halladay celebrates his 36th birthday next week, which would present additional challenges in rehab and recovery from a serious injury or worse, surgery.‘The older the player, the less chance that these injuries heal as effectively,” admitted Shaginaw. “But probably more importantly, the older you are, the more of these kinetic chain-type problems you’re likely to have. As they say, you can’t teach an old dog new tricks. That’s why you see those rigorous strengthening and stretching programs with MLB teams.”So this could be anything from Halladay sleeping in an awkward position and experiencing some discomfort, to a season-ending and career-threatening labral tear?“Yes, it could,” laughed Shaginaw. “It’s hard to give too many specifics—until they do an MRI, we’re all just speculating.”The Phillies’ 2013 season—and the future of one of the game’s best pitchers—may hang in the balance.

What We Can Learn from Basketball Player Kevin Ware

04/05/2013By: Jen WolfeDiscovery Fit and HealthBlogs.discovery.com

Americans love sports because it gives us something to root for.We love the sound of cheers in the stadium, the tangible execution of hard work and success, the sense of comradery and community that comes with loving a team, and ultimately feeling like a part of it.There’s a lot of be learned from one of America’s favorite hobbies and sports culture in general.One of the most important lessons: Keep a positive attitude.Ware scoring against Oregon's Emory during the Midwest Regional NCAA in Indianapolis.

You’ve probably heard about Kevin Ware, the Louisville sophomore who broke his leg in two places – both the tibia and the fibula, and who had to get a 15-inch rod placed in his tibia to help his recovery.Ware was having a pretty bad day.This young Atlanta native broke his leg in a routine move – trying to jump up and block a three-point shot by one of his opponents. He landed with an exposed open-fracture (meaning the bone was protruding through his skin) in front of his team’s bench.Several players and Ware’s coach were in tears at the sight of the injury.Paramedics immediately began treating the athlete who requested to see his coach and teammates before he was taken to the hospital. The injury occurred with less than seven minutes left in the first half.And what did Ware have to say to his coach and teammates moments before he was taken to the hospital?“Win the game!”Ware’s coach Rick Pitino told Fox News:"All he kept saying -- and remember, the bone is 6 inches out of his leg -- all he's yelling is, `Win the game! Win the game!"' Pitino said. "I've never seen that in my life. We're all distraught and all he's saying is, ‘Win the game.' Kevin is a special young man."Justin Shaginaw, MPT, ATC, lead therapist and coordinator for Sports Medicine at Aria 3B Orthopaedic Institute said that Ware’s recovery could take up to a year depending on how clean the break is, but that 80 to 90 percent of these cases recover within a year.The likelihood of Ware coming back at full capability is roughly 60 percent according to Shaginaw; however he says the psychological impact of suffering such a severe injury through a routine play may have a significant impact on Ware’s performance.Ware reportedly came out of his two-hour surgery in high spirits. Coach Pintino said of the team’s win against Duke on Sunday, March 31st, that they did it for him.

If you saw it, chances are you’ll never forget it.In today’s Midwest regional final, Louisville Cardinals guard Kevin Ware suffered a broken leg on a seemingly routine play in the first half against Duke. Ware attempted to challenge a jump shot and landed awkwardly in front of his team’s bench. The game was delayed for about 15 minutes as doctors tended to the fallen player.

Ware, who broke his leg in two places, was resting this morning after successful surgery, the AP reports, in which a rod was inserted into his tibia.We talked to Justin Shaginaw, MPT, ATC, lead therapist and coordinator for Sports Medicine at Aria 3B Orthopaedic Institute about Ware’s road to recovery. Shaginaw works with the United States Men’s Soccer Team and says he’s seen quite a few such injuries on the pitch.“Most of those injuries are caused by slide tackles, where people come into contact with that area,” he says. “I’d say it’s a pretty common soccer injury.”

As traumatic as the injury appeared on TV, Shaginaw is optimistic for Ware’s chances of recovery. He says the key is the type of break sustained. “If it’s a clean break, the fracture will heal fine,” he says. “But if it’s a bad break [with the bone fragmented] then the fracture may not heal [as quickly or easily]. The biggest concern is whether there’s an injury to a nerve, artery or vein.”Television reporters at the game were able only to confirm a broken leg. If that is indeed the totality of Ware’s prognosis, Shaginaw says he’s optimistic at the chances for a return to play.“I would probably say 80-90 percent of players with similar injuries have returned to play,” he reports. “And maybe 60 percent or so are able to return at the same level.”Shaginaw says that the appearance of the injury doesn’t always match the severity of amount of pain the player feels. But with this type of injury, recovery will be psychological as well as physical. Until Ware’s injury, the play couldn’t have been any more routine—a player challenging an outside jump shot. After an incident like this, will Ware be mentally able to return to playing basketball at a high level?“These are tough ones to come back from,” Shaginaw admits. “My guess is that this injury could be somewhat easier to come back from than a football or soccer tackle, because that involves another player injuring you. People can be hesitant to return to that sort of contact. Hopefully since this was more of an awkward landing, it might be a little easier. But he definitely faces a challenging recovery."

My Wrists Hurt While Swimming

Although swimming is a low-impact form of exercise, the repetitive motions can cause several types of painful overuse injuries, including wrist injuries. Fatigue and failure to use proper swimming techniques further contribute to wrist pain and injuries for swimmers, according to the American Orthopaedic Society for Sports Medicine. Obtaining proper treatment, allowing for adequate rest, performing wrist-strengthening exercises and focusing on prevention will help ease swimming-related wrist injuries and minimize the impact of the injury on your performance.Swimming Overuse Wrist InjuriesOveruse of the wrist joint during long swimming workouts and training drills can lead to inflammation and pain. Types of overuse wrist injuries include tendon inflammation, or tendinitis; dislocation; nerve injury; tenosynovitis, or inflammation of the protective sheath around the tendon; tunnel syndromes; and overuse stress fractures. Wrist tendinitis, one of the most common sports-related wrist injuries, often manifests itself as tenderness and aching pain provoked by exercise that subsides upon rest, according to Sports Injury Bulletin. If pain or other symptoms arise, obtain a medical evaluation from a sports medicine physician or an orthopedic surgeon.

Treatments for Wrist PainTreatment depends upon the cause of pain, as well the severity of the injury. Modify your activity and enlist in the help of a swimming coach to learn proper form and to reduce stress on your wrist joints. Physicians often recommend rest and time out of the water during the initial treatment phase to allow the inflammation to subside. Other treatments for wrist injuries include rest, ice, compression, elevation and anti-inflammatory medication, according to the AOSSM. In some instances, doctors may recommend splints, braces, physical therapy or surgery to correct more serious issues.Wrist ExercisesInflexibly of the wrists can cause the radius to touch the wrist bones when the wrist extends while stroking, causing impingement and subsequent pain. Stretch your wrists regularly and perform wrist-strengthening exercises to increase range of motion and strengthen the muscles that hold the wrists in proper alignment, Dr. Kevin Laudner, a kinesiologist at Illinois State University, recommends in a 2014 article for OutsideOnline.com. Try holding a hammer while standing with your arms by your side, tilting the head of the hammer toward the ceiling and then lowering it back down for several repetitions, suggests Laudner. Also try stretching the wrists by periodically moving them back and forth, side to side. See a physical therapist for additional wrist rehabilitation suggestions.Preventing Wrist InjuriesWearing wrist guards, stretching regularly and taking frequent breaks can prevent common swimming wrist injuries, according to the AOSSM. Other ways to minimize risk of injury include using proper techniques and avoiding overtraining. Lessen strain on the wrists by using the sidestroke and other similar gliding strokes in which primary propulsion comes from kicking rather than pulling. Because most swimming wrist injuries are relatively minor, conservative treatments often work well and most swimmers can make a quick return to their sport, explains Justin Shaginaw, MPT, ATC, in a 2014 article for Philly.com. Still, do not allow the injury to go untreated as that may cause a decline in performance and possibly lead to surgery in the future, cautions the AOSSM.

What the World Cup draw means for U.S

www.ghanasoccernet.comSports News | 12 December 2013 15:45 CET

Friday's World Cup 2014 draw was wildly panned by fans of the United States Men's National Soccer Team (USMNT), as the team was selected into the foreboding “Group of Death” alongside Ghana, Portugal and Germany for June's world championships in Brazil.

The matchups alone are enough to give fans apprehension—Ghana, the nation that's eliminated the USMNT from the last two World Cups, alongside perennial powerhouse Germany and Portugal, who feature one of the world's best in Cristiano Ronaldo. But the conditions in which the USMNT will play their games offers equal cause for concern.

Over the course of 12 days, the team will travel over 9,000 miles for their three games—more than any other World Cup squad. What's more, the second of the three games—against Portugal—will be played in Manaus, in the heart of the Amazon rainforest.

Concerns about the conditions have already caused enough uproar to cause the game to moved from 3 p.m. to 6 p.m. local time—out of the worst heat of the day—but this game promises to provide the USMNT with their stiffest test, in terms of conditioning.

“It's going to be difficult—for both teams,” says Justin Shaginaw, MPT, ATC, who's worked extensively with the USMNT. He traveled to South Africa for World Cup 2010.

“Most of Portugal's players are playing professionally in Europe. They're not accustomed to that climate either. If they were to be playing against a South American country in that environment, the South American nation would have an advantage because of their familiarity with the climate.”

Shaginaw adds that people can't focus on the environment in Manaus as the only challenge the team will face. “It may not be as hot as the jungles,” he admits, “but those other two aren't exactly going to be mild, either

In terms of travel, Shaginaw says that the advantage in South Africa was the ability to set a home base, and drive to and from each game. That won't be possible in Brazil, with games being played throughout the nation at points hundreds and even thousands of miles from one another.

It may sound funny, but at least with all the travel the players won't be cooped up indoors all day. Shaginaw explains.

“There are pluses and minuses—in South Africa, we couldn't leave the hotel without security detail—and my understanding is it'll be pretty much the same in Brazil,” he adds. “In Europe, the players can kind of come and go—they can walk around town, have coffee… you can't really do that in Brazil.”

The travel, he added, can be notoriously difficult on team staff members who are responsible for transporting about 10,000 pounds of gear to and from each game. “Warm-up gear, cleats, Gatorade, etc… shipping all that stuff back and forth can take a toll on you,” Shaginaw says. “But for the players? They might like the change in venue—a chance to get out of that same hotel you've been in for the last 20 days.”

In the end, while Shaginaw admits there's a decided advantage for South American sides in this tournament, he adds that there's reason for optimism for USMNT supporters. “If they can make it out of that group, they should have a good shot of going pretty far in the tournament,” he says. “All three of their opponents are strong teams, so if they can make it past that group, that's evidence you've got a pretty strong team.”

How to help your post-marathon recoveryPHILADELPHIA - November 19, 2010 (WPVI)

PHILADELPHIA - November 19, 2010 --Becky Koze is running Sunday's Philadelphia marathon. It will be her second full marathon.She says, after her first, she was so sore it was tough just climbing stairs."I had to take it one little step at a time," Koze said. "It definitely hurts."Physical therapist and athletic trainer Justin Shaginaw says post-race soreness starts within a couple of hours after the race. However, the worst pain typically starts about 24 hours post -race.The soreness is usually felt in your quads, hamstrings, hip-flexors, glutes and calves. But there are ways to minimize the pain:First: hydrate, drinking at least 8 ounces per each hour of running."I would drink at least half of those in electrolyte or sports drink or even tomato juice is a good way to replenish, not just water," Shaginaw said.Also, be sure to stretch either on your own on with a foam roll. Don't forget to stretch after the race, then two more times later that night.You can also try an ice bath. Put cold water and ice in the tub and sit for 10 to 12 minutes.Over, the next few days, Saginaw says try some light activity."Things like walking, getting in a pool, light swimming, stationary bike without resistance," he suggested.As for food, try to eat something with protein after the race, not just carbs.It is also best to limit or avoid taking anti-inflammatory drugs.

2010 US Soccer Men's National Team World Cup PhysicalsMay 16th, 2010

The importance of stretching for Broad Street RunPHILADELPHIA - April 12, 2010 (WPVI)

Get in the Game!Advance for Physical Therapy & Rehab Medicine Vol. 19 •Issue 2 • Page 6 Get in the Game!PTs are finding a new niche working with professional sports teamsBy Rob SeniorProfessional sports in the 21st century have become a gigantic business venture. Owners literally lay out hundreds of millions of dollars to attract the best athletes to their teams. Fans, in turn, lay out thousands of dollars simply to acquire the rights to buy tickets to see their favorite teams play.So it's no surprise that these owners and fans demand the highest performance from their preferred organizations in all areas. That's why many professional sports teams have begun hiring their own full-time physical therapists or rehabilitation staffs. In Major league Baseball, the New York Mets and Los Angeles Dodgers are just two of the teams who have done so.In smaller leagues, it's still more common for therapists to work as team trainers or in another capacity in addition to their full-time jobs.Justin Shaginaw, MPT, ATC, manager of the Sports Medicine Center at Pennsylvania Hospital in Philadelphia, in conjunction with Booth Bartolozzi Balderston Orthopedics, has worked at the team therapist and assistant athletic trainer for the Philadelphia Kixx of the Major Indoor Soccer League for several years. "I've treated quite a few professional athletes—basketball, football, tennis players," said Shaginaw.Shaginaw also works with the United States men's soccer team as an assistant athletic trainer. He was part of the group that won the 2007 Gold Cup, a qualifying event for the 2009 FIFA Confederations Cup to be held in South Africa—another excursion Shaginaw hopes to be a part of."There are a lot of differences in working with world-class athletes as opposed to my typical patients," he admitted. "First of all, with most patients, you are dealing with them, and maybe working with a parent if the patient is underage. With athletes, you deal not only with what he wants, but also the coach, the agent, etc."One group the therapists don't have to worry about dealing with is the media. Sportswriters are notoriously probing with their questions, but it isn't a concern for the PTs."As a professional, you learn the importance of not discussing an athlete's condition during rehab," said Matt Gibble, PT, who works with the New Jersey Nets of the National Basketball Association.Gibble co-owns Excel Orthopedic Rehabilitation with Gary Flink, PT, ATC. Excel has four locations throughout northern New Jersey, and has provided rehabilitation services to such prominent athletes as Jason Kidd, Gary Sheffield and Patrick Ewing.Gibble's career started in an orthopedic clinic that did the rehab work for the New York Knicks of the NBA and the New York Rangers of the National Hockey League. He began by assisting Mike Saunders, head athletic trainer for the Knicks before moving on to start Excel."My partner Gary specializes in hand and wrist rehabilitation," explained Gibble. "So through both our connections, we became more intertwined with the Nets, and assisting their head athletic trainer, Tim Walsh. Gary and I are extremely fortunate to work closely with Tim and and Rich Dalatri, the Nets' strength and condition coach. As a group we have over 90 years' experience in working with athletes."At the time of the interview, Gibble had just returned from working on-court with a couple of the Nets' players, which he said is just as important as the work done in the strength and conditioning room."It allows the injured players to be around their teammates, attend practices and generally be more involved with their team–as opposed to coming to one of our offices," reasoned Gibble.But by the same token, when the Nets go on a road trip, injured players often stay behind to continue their rehab work. Gibble indicated that if asked, he would be able to travel on a road trip with the Nets. However, having the players stay behind in New Jersey is the preferred option.

How to Approach TreatmentHIPAA regulations dictate that the therapist must receive the athlete's permission before discussing his condition with anyone—even a coach or teammate. In many sports, contractual agreements between team and player cover this aspect. Gibble has gone another step, garnering the approval of some prominent athletes to be featured on his company website, www.exceltherapy.comDespite the many people with a vested interest in an athlete's rehabilitation, Shaginaw said he never loses sight of what's most important in his job. "I do what I feel is best for the athlete," he said.At times, this can be troublesome, as athletes will push to get back on the field as soon as possible. But since a therapist must often go against these wishes and treat in the athlete's best medical interest, having confidence in your abilities becomes paramount."I've been treating for 12 years now," said Shaginaw. "I feel pretty comfortable in standing up for what I think is right."Similar to Gibble, Shaginaw started out working for NovaCare, the corporation that handled many of the rehabilitation needs of Philadelphia-area professional athletes. He volunteered his time and made connections with physicians and athletic trainers to make inroads into soccer, his favorite sport. When he got involved with the national team, he started by working with the youth teams before being asked to work with the men's squad. "For the most part, it was a lot of volunteering and extra work on my part," he summarized.Recently, Shaginaw traveled to Sweden with the team–his first overseas trip for work. He said such travel is another perk of the job. "You spend a lot of the time working, and these trips require some quick turnarounds—but you get to experience some interesting places," he said. "I got to be involved with the Gold Cup-winning team, and the Kixx have won two league titles during my time with them. It's always fun to be part of a winning, successful organization."BalanceOne of Gibble's claims to fame is that he helped Nets' point guard Kidd become one of the first athletes to ever return to his sport following microfracture surgery in 2005. "During Jason's rehab, we were able to utilize a pool quite effectively," said Gibble. "He was able to do some deep water running and other closed-chain activities to prepare him to return to the court."Both Gibble and Shaginaw cautioned the "die-hard" fans out there from pursuing this line of work simply to get closer to athletes. 'It's great to be a sports fan, but the number-one thing is to remember that as a professional, the athletes are looking to you for help," said Gibble. "So it's important to maintain a professional relationship.""There's something to be said for achieving a balance," added Shaginaw. "You don't want to go into it as a fan, but it helps to have a level of interest. If you know nothing about the athlete or the sport, they'll see right through you. It always helps to have passion about your job."Shaginaw indicated his own experience as an amateur soccer player has been beneficial when talking to the players about their injuries. Both he and Gibble were quick to advise avoiding requests or activities that are more fan-friendly, such as getting autographs from players."It's important to just learn to treat them from a physical therapist's prospective, like any patient," added Shaginaw. "At first, I was a little nervous around some of the athletes, but I learned to adjust very quickly and concentrate on providing treatment."Shaginaw has also learned to balance his job at Pennsylvania Hospital with working in soccer effectively. "Luckily, the hospital's fairly lenient in terms of allowing me to take time away from work," he said. "Plus, it's good marketing for the clinic–being able to say that we work with the U.S. national soccer team gives us some added ability to attract patients. I also have some great co-workers, so the level of care doesn't suffer in my absence."As co-owner of his clinic, Matt Gibble feels it's important to include his other physical therapists when working with professional athletes. "I like to get my staff involved," he said, "because it's fun for them, and helps to build a true sense of camaraderie among our team. I will often bring a fellow PT to the Nets' practice facility to work with players, which for them is a lot of fun."The job is certainly unique, and can be demanding, but neither Shaginaw nor Gibble would trade places with any other therapists. Asked what his idea of a "dream job" would be, Shaginaw replied, "I think I am pretty close to it right now."

Capital Expenditures Gear Up to Usher in a for a New DecadeRehab Management Published on January 6, 2010

Rehab Equipment for a Sports Clinic—Basics to Wish List

When purchasing equipment for your outpatient clinic, first identify what equipment you really need: “the basics.” Then, you will want to consider adding “bonus items,” which can take your clinic to the next level. Finally, you’ll want to research and consider the “big ticket rehab tools.” These are the items that can transform your clinic into a state-of-the-art facility. Consider the size and the cost. Bulky machines can take up floor space—usually in high demand in most clinics (also, more floor space is needed for sport-specific activities, such as plyometrics, agility drills, and return-to-sport testing). Last, equipment such as treadmills and weight machines can be costly. Make sure you are making the best use of your clinic’s budget.The Basic ListMost clinics have some, if not all, of these items already.A good stationary bike and an elliptical machine should be part of almost every clinic already.One of my favorite tools is a simple foam roll. It is great for self-stretching, massage, and myofascial release.Balance and neuromuscular control are key to good outcomes with all of my patients. I make sure to have a variety of balance toys available in the clinic. These are relatively inexpensive, provide different levels of instability, and add variation to the rehab programs. Balance discs, foam pads, wobble boards, and, most importantly, a flat-based exercise ball—a “must-have” piece of equipment.Physioballs can be used in ROM exercises, core stabilization, and even proprioception/neuromuscular control exercises. Some of my favorite exercises are prone planks with elbow circles for core stabilization, supine hamstring curls for hamstring and glute strengthening, and single and double leg squats on the physioball for neuromuscular control.A slideboard is another great tool that can be used in numerous ways from general cardio exercises, to hamstring and adductor strengthening, to core stabilization. Speed ladders are a great tool for return-to-sport progression. The newest piece of equipment in our clinic is a suspension training system, which uses the patient’s body weight as resistance while incorporating core stability—and it replaces numerous pieces of equipment in our facility.Last is a step-up box or plyometric box, which I prefer, so I can also do plyometric and force attenuation exercises.The Bonus ListA good treadmill that goes at least 10 mph will allow you to initiate running programs under a controlled environment so you can monitor gait and assess for any deviations.Strength training machines offer less core activation and they’re not functional or sport specific, but there are times when patients may benefit from strength training exercises on these machines.An adjustable cable column machine gives you plenty of options for upper and lower extremity strengthening, core stabilization, and functional training. You’ll need enough space around the unit to allow you to perform functional and sport-specific exercises such as the standing single arm press and row.Vasopneumatic cold compression units are great tools for both postsurgical patients and the everyday sprains and strains associated with sports clients. The portable unit combines the positive effects of compression and cold therapy to reduce pain and swelling.Vibration therapy is new to the rehab setting. We have found it to be effective in improving proprioception/neuromuscular control in our lower extremity patients. It can be highly effective in improving flexibility when performing self-stretching and mobilization exercises.Weighted vests allow you to do much more functional and sport-specific exercises compared to having the athletes hold dumbbells, tubing, or medicine balls, which limit the ability to perform specific movement patterns and put the resistance outside the athlete’s center of gravity.The Big Ticket ListFinally, I have a list of equipment I would purchase if I had an unlimited budget.The first item is an antigravity treadmill, which allows you to reduce body weight by up to 80% and attain speeds as high as 18 mph. It enables partial weight-bearing ambulation without an assistive device, initiates running while decreasing weight-bearing stresses, and even performs partial weight-bearing exercises without the belt moving.Next is an isokinetic unit for lower extremity strength testing with return-to-sport assessment. These units give valuable side-to-side strength comparisons when determining if an athlete is ready to initiate a return-to-sport program. They also have some benefit with high velocity and eccentric training.Another big purchase would be a computerized balance assessment unit. The unit in our clinic enables us to perform numerous tasks giving us side-to-side comparisons, which we use in determining an athlete’s neuromuscular recovery.The last item is an air resistance cable column unit that enables high velocity movements for functional and sport-specific training with fluid, consistent resistance that plate resistance units don’t allow.The right equipment will help you perform assessments that give objective measurements on a patient’s progress with rehab. Knowing when to use and not to use each piece of equipment may be more important than what you purchase for your clinic.Justin Shaginaw, MPT, ATC, manager of sports medicine, Good Shepherd Penn Partners Penn Therapy and Fitness at Pennsylvania Hospital, Philadelphia.

POUNDING THE ALARM Tackling the obesity threat to children and older adults.

“Teachers see the teasing and bullying; school counselors see the depression and lowself- esteem; and coaches see kids struggling to keep up, or stuck on the sidelines. Military leaders report that obesity is now one of the most common disqualifiers for military service.Economic experts tell us that we're spending outrageous amounts Of money treating obesity-related conditions like diabetes, heart disease and cancer. And public health experts tell us that the current generation could actually be on track to have a shorter lifespan than their parents.

“None of us wants this kind of future for our kids or for our country.

So instead of just talking about this problem,instead of just worrying and wringing our hands about it, let's do something about it.Let's act ... let's move.”

So said First Lady Michelle Obama at the launch of her “Let’s Move” campaign, a public- and private-sector initiative with the stated goal of solving the problem of childhood obesity in America within a generation.

The list of health effects from obesity is long and troubling.It includes hypertension, type 2 diabetes,hypercholesterolemia, osteoarthritis,coronary disease, liver disease, stroke, disability and mortality.In the last 30 years, the percentage of U.S. citizens that can be classified as obese has gone from under 15 to at least 20 in every state but one(Colorado is the lone holdout).Nineteen states are in the 20 to 24 percent range.In the other 30 states, at least 25 percent of their population is obese.And that’s not even counting those of us who can be classified as overweight.

“Overweight” is the clinical categorization for people whose body weight is considered unhealthy for their height.The Centers for Disease Control uses the following definition:“For adults, overweight And obesity ranges are determined by using weight and height to calculate a number called the body mass index.BMI is used because, for most people, it correlates with their amount of body fat.An adult who has a BMI between 25 and 29.9 is considered overweight.An adult who has a BMI of 30 or higher is considered obese.” We know about the medical problems that can arise from being overweight.We’re deluged with information from all media sources.

The diet industry rakes in tens of billions annually with programs, books, tapes, packaged foods and the like.We know that.Yet here we are: all trying diets, all drinking sugar-free soda, all gaining weight.And we all know the secret to losing weight is to eat less and exercise more.So if we “responsible adults” know this simple fact and are still powerless to stop the inexorable rightward movement of the bathroom scale, how can we expect our children to fare any better?

Pinching the Cheeks

The bad news is that childhood obesity is on the rise. Dramatically.

Mrs. Obama states that “nearly one-third of children in America are now overweight or obese—one in three.” Medical professionals have no problem describing it as an epidemic. The good news is that children can be chubby and still be in the normal BMI range.

So what’s wrong with being an overweight child?The big problem is that, if you are overweight in childhood, you are more likely to be overweight in adulthood, which is more likely to lead to obesity, which is more likely to lead to diseases that are exacerbated by the extra pounds and fat and cholesterol, etc. Think this is unduly alarmist?

Think again.In this country today, approximately 15 percent of children under 18 qualify as obese.

When a child reaches the point of obesity, professional intervention is a necessity.According to a 2005 report from the Institute of Medicine, “Preventing Childhood Obesity:Health in the Balance,” 60 percent of obese children aged 5 to 10 have at least one cardiovascular disease risk factor. The report also highlights a secondary harm that can come from childhood obesity: “Young people are at risk of developing serious psychosocial burdens related to being obese in a society that stigmatizes this condition, often fostering shame, self-blame, and low self-esteem that may impair academic and social functioning and carry into adulthood.”

In response to the childhood obesity epidemic, The Children’s Hospital of Philadelphia established the Healthy Weight Clinic.Founded in 2005, the clinic is for children ages 4 to 17 who fit the definition of obesity and have a qualifying weight-related condition: type 2 diabetes, prediabetes, dyslipidemia, hypertension, fatty-liver disease and/or obstructive sleep apnea.The clinic’s goal is to provide support and information for the families of obese children.Significant weight loss and healthy choices are best accomplished in a team environment that includes primary-care providers. The clin-Ic gives the child a full evaluation from which they will coordinate development of a care plan with any specialists and support personnel that are needed.

“We talk about what it means to be healthy, then talk about how the whole family can get involved in making good choices,” says Dr. Shirley H.Huang, the medical director of the clinic.The choices include diet and exercise in pursuit of weight loss, though the clinic isn’t involved in weight management nor is it a gym.

Though the Healthy Weight Assessment Clinic is specifically for obese children referred by their doctors, the information given to the families is good for anyone who wishes to pursue a healthier, more active lifestyle. Healthy weight is a concern even before a child is born.Prenatal nutrition, recent studies show, may have a lot to do with the likelihood of being overweight or obese throughout a person’s life. It’s the parents’ and doctor’s responsibility to monitor children’s BMI and watch for drastic changes.Parents can provide their own evaluation of their child’s lifestyle, too. It’s all stuff you’ve heard before, but it bears repeating:

• Keep screen time down, including TV, computer and video games

• Eat meals as a family, at a table, without TV

• Walk from place to place as often as possible and take the stairs in lieu of escalators and elevators When asked about factors that have caused increases in overweight and obese children these past few decades, Huang rattles off a list that includes: fast food, portion sizes, higher-calorie foods, escalators, dangerous neighborhoods, suburbs, lack of nutritional information provided to parents … you get the idea.

It’s never advisable to put your child on a restrictive diet without a doctor’s supervision.We’re warned that limiting a child’s diet could be harmful to their health and impede their growth and development.

(As if kids don’t limit their own diets just fine, thank you.)The good old food pyramid is a fine place to start. Keep that in mind and keep shoving the fruits and veggies at them. The frustrating part: “You liked peas yesterday! You love mandarin oranges from the can—this is the exact same thing!” The food battle, in the end, is less like kicking down a screen door than clawing your way through a solid oak door with a deadbolt, chain and one of those bars that they have in New York apartments.

“Pediatric obesity is very complicated,” says Huang.“Research shows which interventions work. Those which focus on family-centered activities help make long-term changes possible.” Get Up, Get Out, Get Fit “There are many different ways to improve every day,” Huang says about helping families in the clinic.She suggests that a good place to start is the 5-2-1-0 campaign. Former Philadelphia Flyers and 76ers physical conditioning coach Pat Croce also endorses the campaign.A passionate fitness enthusiast, Croce has been working with Children for decades, promoting activity and physical education.“The 5-2-1-0 is a cool little campaign developed by my friends at Nemours Health and Prevention Services to promote a healthier lifestyle for children and their families.It consists of four easy strategies for healthier eating and physical activity”:

• 5 servings of fruits and vegetables a day

• 2 hours of screen time a day (which also includes texting)

• 1 hour of physical activity

• Almost no sugar-sweetened drinks, including sports and juice drinks Croce’s other fitness suggestions mirror Huang’s. None of these are difficult, but they do require us to pay more attention to our kids.

And to get up off our butts, which, surveys show, we can all do more of. He suggests taking this one step at a time.Work on one practice— say, a walk after dinner—until it becomes a habit.Then work on developing the next good habit.“It’s as simple as calories consumed and calories burned—even though the prevention and treatment is anything but simple.Because it starts with you!” Croce is also a motivational speaker, so he mostly ends sentences in exclamation points.

Huang answers the question about determining the best workout for children of different ages with questions of her own:“What do they like to do? What’s fun for the whole family?”An hour of physical activity need not be in a single chunk. Kids tire faster and have shorter attention spans than adults, so a family bike ride or an hour of one-on-one basketball may not fit. It doesn’t have to be structured like a karate class. It could be gardening, dancing or tag.

Since there are no restrictions on appropriate activity for children and families (OK, bear wrestling and go-play-in-traffic are out), any activity you can think of counts toward your good parent award.Your local JCC is a great place to look for classes, teams and other activities that the family can enjoy.

Take Time to Take Care

In a 2007 report in the Journal of the American Medical Association, two University of Pennsylvania School of Medicine researchers found that obese people 60 and older are much more likely to suffer from disability than those a decade younger.Dawn Alley and Dr.Virginia Chang compared health data from 1988-94 with that from 1999-2004.They found that while disability was decreasing in the non-obese older population,it did not decrease for the obese. Chang says, “We believe that two factors are likely contributing to the rise in disability among older, obese people.

First, people are potentially living longer with their obesity due to improved medical care.Second, people are becoming obese at younger ages than in the past.In both instances, people are living with obesity for longer periods of time, which increases the potential for disability.”

However,a little bit of exercise and a moderate change in weight can do a world of good for a senior citizen’s health.And it’s never too late to start.Seniors even get to have higher BMI numbers (26 or 27 is considered in the normal range) and still be in the healthy parts of the charts. But as you might guess, every cheesecake you eat in your 40s contributes to the belly you carry around in your 70s.

When one combines being overweight with any of the other health factors that tend to affect older individuals, problems are multiplied.

High blood pressure and being overweight do not play well together, though they do often walk hand-in-hand. High bad-(LDL), low good-cholesterol (HDL) can be trouble, though once you reach 65, blood cholesterol level is less of a risk factor in heart disease.And, seriously: no smoking.Obesity is a bad state to be in no matter what age you are.That’s pretty much the reason for the classification.

You’re out of the range of healthy weights at that point.

“So many different disease processes or metabolic processes can be traced to obesity,” says Justin Shaginaw, a physical therapist and athletic trainer who works with patients at Penn Therapy & Fitness at Pennsylvania Hospital. Shaginaw sees all shapes and sizes there and has some advice for seniors who are ready to(or are ordered to) put together an effective exercise and fitness plan.He believes that everyone from children to seniors should work their bodies in four areas: strength, cardiovascular, flexibility and balance.Everyday activity just isn’t enough because you will invariably ignore one or more of these. Shaginaw also says that healthy eating is an absolute must.

He notes that studies show that people tend to stick to more consistent exercise when they join clubs or take classes.He also agrees that seniors should work with their primary-care doctors before they embark on an exercise campaign.Together, they can set goals to achieve health-related results as well as personal ones.Shaginaw also endorses the idea of seeking out a physical therapist or personal trainer at least once, but cautions to check the credentials and experience of personal trainers because the only schooling they may have had is an online course and a one-day test.

The Senior Advocate (senioradvocatenews.com), one of the Web’s best sources of information for active adults, distills weight loss suggestions from the National Heart,Lung and Blood Institute:

• Get 30 or more minutes of moderate exercise on most days of the week

• Read nutrition labels and write down what you eat in a diet diary The Senior Advocate notes that “people who are successful in losing weight and sustaining that loss are those who make small changes in their lives that they continue over time.Consistently getting more physical exercise and eating healthier meals are the best ways to achieve this.It takes about eight to 12 weeks to begin To notice these effects on blood pressure and cholesterol and to feel better.” Unlike all the grunt-sweat-pay exercise programs/equipment that adults ages 20 to 50 crave, seniors get to elevate their heart rates while sitting in chairs,listening to nice music or enjoying a swim.

Not only that, but most of the classes and facilities that are geared toward seniors are either low- or no-cost.Even the insurance companies step up with an “attaboy,” a pat on the back and a wheelbarrow full of money.Or at least incentives.

We Called Them “Tennies”

SilverSneakers (silversneakers.com)is a nationwide organization that provides training and class programs designed for senior citizens of varying physical abilities. SilverSneakers is a part of Healthways,a provider of healthy living support solutions.Healthways develops programs that seek to help healthy people stay healthy and to mitigate the health risks in people who already struggle with disease due to genetic or lifestyle factors. Besides the classes designed specifically for seniors and taught by trained instructors, participation in SilverSneakers also gets you a free fitness center membership, a fitness adviser and personalized reports on your progress.

Popularity is the goal of all SilverSneakers programs.Tricia Grayson, director of external communications for the program, says,“The SilverSneakers program was designed with participation in mind.CDC [Centers for Disease Control]studies have found that the more our members participate,the more their health is improved and the lower their health care costs become.”In Greater Philadelphia,SilverSneakers is available through Independence Blue Cross(as well as Bravo Health, Geisinger Health Plan and Highmark in Pennsylvania),but the Signature SilverSneakers classes are offered throughout the region.There are four group exercise programs available:Muscular Strength & Range of Movement; Cardio Circuit Class; SilverSplash; and YogaStretch Class.

The JCC Stiffel Senior Center offers a number of exercise classes which are open to everyone and free to members of the center.One of the area’s first SilverSneakers participants, they host a Muscular Strength & Range of Movement class.There’s also a Stretch, Strengthen and Balance class and Gentle Chair Yoga.The average participant is in their 80s, so these classes are very low-impact.The very popular line dancing class, taught by Sheila Zagar, teaches the latest dances along with the classics.

Kaiserman JCC in Wynnewood has a SilverSneakers class on Tuesday and Thursday mornings and group fitness classes throughout the week.Kaiserman is a full-service community center with a fitness center, pool,a slew of enrichment classes for young and old as well as a preschool and kindergarten and summer camps.

When you get really serious, you may want to invest in the one-onone personal training sessions, which will surely lead to the necessity of multiple visits to the massage therapist.

Martins Run, the senior living community located in Media, recently opened a new state-of-the-art fitness club that’s open to both residents and non-residents.The 9,000-square-foot facility includes a pool,a full fitness center with special, senior-friendly Keiser pneumatic equipment and a health bar. Linda Beaver is the physical fitness coordinator at the club. She explains the benefits of regular exercise for seniors.

“The stronger you are, the easier it is to get out of a chair or the shower.

The more flexible you are, you have better body awareness, which helps to keep you from falling or getting hurt if you do.” Trainers at the Fitness Club at Martins Run will work with seniors to develop the best plan that meets their goals and physical challenges.Balance and endurance will be tested, goals will be discussed and then each person will be free to pursue their activities independently.Beaver suggests that a senior who has been living a sedentary life should consult a doctor before getting started, but she says a good way to begin is with 15- to 20-minute workouts two times a week and then gradually build from that, varying the workout to keep it fresh.

Another benefit of a regular fitness routine, Beaver says, is an increase in mental capacity.Increased oxygen flow also helps to mitigate the effects of dementia, patients can be weaned off of diabetes drugs, and muscle and bone loss—a result of the aging process— can be slowed.She likes to work with seniors who are willing to push themselves a little.Accepting their own physical challenges and meeting their goals, she says, are successes that they can carry into other areas.

Resources are in place for both juniors and seniors to get together with professionals to work out a plan to lose weight and live a more healthy lifestyle.With a national movement reminding us of the importance of this change, there’s no excuse to keep making the same mistakes.As Michelle Obama says, “Let’s move.”

A sudden twist, a shriek of shock and pain, and an athlete collapses onto the court or field like a marionette whose strings have been severed. If there wasn’t an audible “pop” at the time of the incident, in a few hours there will be the telltale swelling around the knee joint; chalk up another victim to that now-infamous injury, a tear of the anterior cruciate ligament (ACL).It’s an all-too-common occurrence in high school and college sports, and the unfortunate truth is that for female athletes, especially those aged 15-20, it is an injury that’s more likely to happen to them than their male counterparts.The reasons for this disparity, along with many other facets of this unfortunate phenomenon (including prevention) were explored on the evening of Sept. 14, when Springside School presented a seminar entitled “ACL Injury in the Female Athlete.”The headline speaker, renowned orthopedic surgeon Arthur R. Bartolozzi, explored the technical complexities of ACL injury and repair while keeping his talk entertaining for several hundred audience members at the all-girls school.A former team physician for the Philadelphia Eagles and the Flyers, Dr. Bartolozzi performs more than 800 surgeries each year, most of them related to the knee and shoulder. He is a member of the staff at Pennsylvania Hospital in Center City Philadelphia, and is a principal provider of services at Booth, Bartolozzi, Balderston — 3B Orthopaedics in Cherry Hill, N.J.The function of the ACL“The ACL is a very important ligament to stabilize the knee,” Bartolozzi began at the Springside gathering. “It’s a tiny little thing, half the size of your pinky finger. Who would think something so little could cause so much trouble?”Showing slides of a model of the knee, he pointed out the femur (thigh) and tibia (shin) bones, and the cushion between them, a layer of cartilage known as the meniscus. The meniscus may suffer collateral damage at the time of an ACL injury, or afterwards if the ACL tear is not repaired properly. The resulting bone-on-bone contact leads to a world of hurt.Deep inside the knee, the ACL runs through its own slot, referred to as the notch. Without this connective band helping to hold the knee joint together, Bartolozzi said, “The femur rolls off the back of the tibia.”When the limping ranchhand in a Hollywood Western exclaims “Ma trick knee done went out on me,” he’s got a damaged ACL and the two major leg bones have slipped out of alignment.Some victims of the injury may be able to ambulate or even play a sport, with a damaged ACL – for a time. If the tear is not repaired or healed, however, even the best outcome will probably involve the onset of arthritis at a relatively young age. More likely is an additional injury such as a tear to the meniscus, which is subject to abnormal stress when its little buddy, the ACL, is not functioning properly.Girls at greateer riskBartolozzi noted that there almost 100,000 ACL injuries in the U.S. each year, and among young athletes, girls suffer much more than boys.“In the past few years, what we’ve identified is the very important gender-specific association – that’s female versus male association – with ACL injuries,” Bartolozzi said. “Studies in various sports and athletic activities showed that girls injure ACL’s between two and seven times more than boys [the figures vary between different sports]. There is a higher incidence all across the country, at all levels in sports.“There have been many studies, and there has been a lot of media coverage of this problem,” continued Bartolozzi, who noted that in addition to the physical damage, there can be psychological effects from these injuries, a “grief reaction” stemming from the loss of a favorite pursuit, and of the kinship of teammates.Citing probable causes for the discrepancy between the sexes in the frequency of ACL tears, the speaker started with basic anatomy.He observed, “We know that girls have a broader pelvis than boys, and more often than not, they’re knock-kneed [whereas boys tend to be bowlegged]. The shape of the bones is different, so the place where the ACL lives inside the knee, called the ‘notch,’ is smaller in girls, and the ACL itself is smaller than in boys, and that’s in people of the same height. Girls have somewhat weaker muscles, and hormones have been shown, in some cases, to effect the laxity of joints.”Bartolozzi displayed another set of slides illustrating clinical motion studies. One exercise simply involved stepping up onto a low platform, and in the front view the doctor pointed out that the position of the boy’s leg remained pretty much straight up and down, while the girl’s knee bent inwards a bit. In the side view, there were differences in the relative angles of the pelvis and upper and lower legs.“Girls, when they jump and land and run and cut, are totally different, and it’s hard to figure out why that is,” Bartolozzi said. “When they jump in basketball, boys land in a crouch with bent knees, and girls land on straight legs.”He also mentioned a Duke University study of shearing stress - on the knee joint overall and on the ACL - which indicated that girls generate more rotational force when they land.The bottom line appears to be that the ways in which the female athlete typically moves often places her knee joint in what the doctor called, “an ACL-averse position.” The more a girl can play “on top of her feet” the better, he said. Injury is more likely when force is applied to a leg that is splayed out in one direction or another.More exposure, more dangerWith the explosion in women’s athletics over the past few decades, even very young girls are playing more sports, and playing them longer and harder. Bartolozzi pointed out that many of his teenaged patients are participating in school sports and in several club leagues at the same time. There seems to be no “off-season” anymore, but the doctor advises scholastic athletes and their parents to create one. He recommends a full month off from sports after every five or six months of continuous participation.The increasing use of artificial turf fields, another modern trend, has also taken a toll on athletes’ knees.Bartolozzi explained, “If you wear turf shoes on turf it’s like Velcro, because nothing gives. That grip comes at a cost.”He added that shoes with long metal spikes used on grass fields have a similar effect; if the playing surface and the footwear don’t give, more stress is likely to be transferred to the soft tissue of the athlete.The doctor cautioned: “Try to minimize how much exposure you get from high-traction equipment, whether it’s on grass or turf, because that can lead to increased incidence of injury. We’ve advised post-operative patients to use flats on turf or turf shoes on grass.”Strides in surgical techniquesWhile physicians and researchers continue to piece together the data regarding the incidence of ACL injuries and predisposition to them, there have been great strides in treatment.A torn ACL suffers from poor blood supply, which limits its ability to heal on its own. Surgery is usually required, and is almost inevitable for an athlete wishing to return to action. Simply stitching the torn portions of the ACL back together was proved ineffective long ago, and the tried and true method of repair involves tendon grafts, commonly from the patella, hamstring, or quadriceps. The use of synthetic materials in ACL repairs was tried, and then abandoned, in the 1980s.Back in the 1960s, a severe ACL tear was a career-ending injury for athletes such as New York Jets quarterback Joe Namath. Over the next decade, successful surgical techniques were developed to repair the ligament, although these early operations were, frankly, quite gory.A collective queasy moan issued from the audience at Springside when the guest speaker showed a slide depicting a knee joint laid open like a gutted fish.“You had to open it up to see everything,” the doctor explained. “You had a 12 or 15-inch incision, with one week in the hospital and a gigantic zipper [scar] on the knee, so things have changed over 20, 30 years.”The advent of arthroscopic surgery, which employs a tiny video camera with a light source along with equally dainty instruments, greatly reduced the invasiveness of the procedure.“The camera is fed to a monitor, and the surgeon operates through small holes,” Bartolozzi said, “so all you end up with is a couple little holes in the knee. But the actual inside-the-knee surgery is exactly the same as it was when we opened it all up.”A relatively low-tech method of diagnosing ACL tears is still in use and remains effective. Involving manual manipulation of the knee joint, it’s called the Lachman test, and was developed by the late John W. Lachman MD, a former Chairman and Professor of Orthopedic Surgery at Temple University who passed away in 2007.“The truth is, to diagnose these injuries, you really have to do old-fashioned medicine and examine the knee,” Bartolozzi said.ACL injury preventionIn addition to the great advances that have been made in the treatment of ACL injuries, today’s athletes have available to them a number of preventative programs and exercise regimens aimed at avoiding knee problems in the first place. Some are complex and require specialized equipment, but Bartolozzi also discussed the more easily implemented PEP (Prevent injury, Enhance Performance) program developed by the Santa Monica (Calif.) ACL Prevention Project, which also operates the Web site ACLprevent.com.It was originally created for female soccer players, but can be easily adapted for most other sports. Designed with intercollegiate and interscholastic teams in mind, “PEP” features many elements which can be incorporated into a pre-game warm-up routine.Dr. Bartolozzi was joined at the Springside seminar by several of his colleagues, including Justin Shaginaw MPT/ATC, Director of sports medicine rehabilitation at Booth, Bartolozzi & Balderston. Formerly a physical therapist for a number of professional sports teams, Shaginaw has trained and treated elite-level female soccer players, including U.S. Team members, and he’s well-versed in the “PEP” program.“It’s almost 80 percent effective at preventing non-contact ACL inuries,” he said.A former collegiate wrestler and soccer player, Shaginaw has now worked with so many athletes both before and after injuries that he often can identify a predisposition to knee problems just by looking at a person’s physique and the way they move. He actually did this with a few courageous volunteers from the Springside audience.Sizing up one sophomore and learning that she ran cross country during the fall season, he advised her to stick with it and not contemplate a switch to a sport like soccer, with its relatively high risk of ACL injury. Shaginaw explained that with her structural characteristics, she would probably want to take a cautious approach to sports such as basketball, soccer, and volleyball, which routinely demand quick, abrupt lateral movements that place the knee in jeopardy to a considerable degree.Generous with their time and knowledge, Bartolozzi and his panel of experts stayed for some time after the seminar ended to address the concerns of individuals. Before the group session broke up, however, a Springside parent asked a question that probably occurred to many members of the audience: After recovering from an ACL tear, is a person more likely to suffer a similar injury than someone who’s never had major knee problems?“The data on that is a little bit concerning right now,” Bartolozzi responded. “If you tear your ACL you can return to full 100 percent activity without a lot of restrictions, but your chance of re-tearing that same knee or tearing the other knee goes up 50 times.”There’s not a definitive explanation for this, he went on; a combination of factors probably contributes to this sobering statistic.At both the beginning and the conclusion of his talk, Bartolozzi commended Springside for setting up last week’s seminar, and he praised the driving force behind it, Assistant Athletic Director Aimee Tycenski Keough. Keough is also an athletic trainer with multiple certifications, and Bartolozzi said that thanks to her knowledge and leadership, Springside already has an effective ACL injury prevention program in place.

Justin Shaginaw, MPT, ATC, started playing sports at a young age. He attended Gannon University, Erie, PA, on a wrestling scholarship and walked onto the soccer team as well. So it was only natural the physical therapist pursued his passion when exploring career options.To acquire hours for his ATC examination after physical therapy school, Shaginaw volunteered with the Philadelphia KiXX, an indoor soccer team that is part of the National Indoor Soccer League. Twelve years later, he serves as the team physical therapist and assistant athletic trainer, as well as the assistant athletic trainer for the U.S. Soccer Federation's Men's National Team."I love taking care of all types of musculoskeletal problems, but nothing is more exciting than working with a professional team," he insisted.Especially a championship team. The KiXX won the Major Indoor Soccer League (MISL) championship in the 2001-2002 season, and again in 2006-2007.Shaginaw admitted the work is challenging and there are lots of demands. However, he added that being part of a professional team makes the long hours, hard work and travel worthwhile."Your work can sometimes be the difference between a winning and losing season," he said.A Rock-Solid RelationshipRehabilitation is a vital aspect of caring for KiXX players. As the manager of sports rehabilitation at the Good Shepherd Penn Partners (GSPP) outpatient site at Pennsylvania Hospital in Philadelphia, PA, Shaginaw uses the rehab equipment in his clinic to provide the comprehensive care needed for extended treatments and for care during the off season.A close working relationship exists between Shaginaw and Jim Bollinger, ATC, CSCS, head athletic trainer for the KiXX and fellow GSPP member of the sports rehabilitation team at the Pennsylvania Hospital outpatient site. Shaginaw assists Bollinger with rehabilitation of athletes, especially those whose injuries have resulted in extended time lost from playing."We have a strong relationship with our physical therapists," said Bollinger, who is presently serving his tenth season as the team's head athletic trainer. "I know that I can have players go to them anytime for treatment and trust that we are all on the same page."As a result of the close communication and consultation, the KiXX sports medicine team has become well-respected within the community at large. Organized by Arthur R. Bartolozzi, MD, chief of sports medicine and program director of the Orthopaedic Sports Medicine Fellowship at Pennsylvania Hospital, the medical team includes specialists in all medical fields-from internal medicine, cardiology and hematology to podiatry, dentistry and dermatology to name a few.Aside from constructing the KiXX medical team, Dr. Bartolozzi has worked as the physician for the team since its inception. His impressive sports medicine background includes serving as the team physician for many of Philadelphia's other sports teams, such as the Philadelphia Eagles football team, Philadelphia Flyers and Philadelphia Phantoms hockey teams, and the Philadelphia Rage professional women's basketball team. His experience with these professional teams helps Dr. Bartolozzi understand the importance of collaboration within the medical team.

'If I'm Lucky I Get to Watch the Game'The partnership between the physical therapist and athletic trainer can be important in optimizing effective care for athletes. Early detection, diagnosis and implementation of an effective treatment program are key. To help prevent injuries, Bollinger incorporates core strength programs, proprioceptive training, flexibility programs and stability ball programs with an emphasis on the hamstrings into his fitness sessions.Not all injuries can be prevented, and one of the most common injuries to players is sacroiliac (SI) joint dysfunction with associated hamstring injury, noted Bollinger. Muscle energy techniques, traction, massage and stretching are used to treat this.On an intermittent basis, Bollinger treats eye injuries caused by ball contact, as well as wrist and hand injuries, medial collateral ligament (MCL) sprains in the knee, ankle sprains, sports hernias, hip labral injuries, cervical and lumbar disc bulges or herniations, muscle strains and spasms, tendonitis, turf toe, plantar fasciitis, abrasions, lacerations, MRSA infections and illnesses."Concussions also occur and can range from minor to very serious. Many careers have been challenged or ended by concussions. In the past we used to call minor concussions 'dingers' or 'getting your bell rung,' but now we know that even those that appear to be minor can in fact have serious consequences," said Dr. Bartolozzi.Because Bollinger works full time for the team, he must be available during all practices and games. On a typical day, Bollinger arrives 1.5 to 2 hours prior to training in order to set up. Players begin arriving 1 hour prior to training for treatment, which consists of taping, splinting, modalities (heat, ice, ultrasound, e-stim, etc.) massage, stretching, manual therapy techniques and proprioceptive training."During training, I watch the session and monitor players, or if there are injuries I put the players through their rehabilitation and fitness programs. I often run fitness sessions for the entire team," said Bollinger.During post-training, players finish their rehab programs and Bollinger uses the same types of treatments mentioned. If a player gets injured during the session and needs to see a physician, he will accompany the player to his appointment or to the emergency department.Game day follows the same routine. "I often need to evaluate players prior to the game to determine if they are fit to play. Then, if I'm lucky I get to watch the game without having to take care of any injuries," he said. "If there are injuries, I assess them to determine if the player can continue to play and then coordinate the appropriate follow-up care: physician, ER, PT or OT."

Treatment in Substandard SettingsShaginaw noted that, at times, he and others on the medical team must treat players in suboptimal environments. While general rehab is usually completed either at the practice facility or in the physical therapy clinic, as the need arises, players are treated on the field, on the sidelines or in the locker rooms. Bollinger has even treated players on buses, planes, in hotel rooms and in the back of his car.Flexibility is paramount, according to Shaginaw. "You don't always have the facility, equipment or time like you would in the typical clinical environment. We need to treat a player quicklyto get them back in the game, or decide that they can't go back so that the coaching staff can make the appropriate changes."It's not the lack of equipment, modalities or space that keeps Shaginaw from treating players; the largest barrier as he sees it is time."Players don't have the luxury of being treated over days or weeks. They need to be better, or at least able to play, in a matter of minutes," he explained. "This is the most difficult obstacle when treating athletes compared to your average patient. With your average patient, you treat them until they are 100 percent before you return them to their sport or activity. With athletes, we have to balance a fine line between patching them up so they can play and not sending them back if the risk of injury is too high."Bollinger concurred. "You often only have seconds or minutes to decide if a player can continue to play or if he needs to be held out. If the player is able to return, you must quickly prepare him to return-tape, brace, splint, bandage, stretch or massage."The training room and field present a unique challenge when evaluations are performed during a game situation, noted Dr. Bartolozzi. The excitement and intensity of the game, coupled with the urgency of treatment, make the environment a far cry from the peacefulness and privacy of an office environment.Therefore, the challenge is to obtain all necessary information from the player, perform a thorough exam and then effectively communicate the nature and extent of the problem to the player."In cases of potentially serious problems where the player wishes to return to play, the noisy environment and the pandemonium of the game make it especially important to work expeditiously and communicate effectively," he said.

A Labor of LoveTreating professional athletes in the locker room, on the field, even in the back of a car, might be too taxing for some-but for Dr. Bartolozzi, Shaginaw and Bollinger, the chaos is what keeps these health care professionals coming back."I find the professional athlete as a patient to be a very challenging, but most often very rewarding as a sports medicine physician," revealed Dr. Bartolozzi. "Because of the level of commitment to excel on the field and the level of commitment required to achieve the performance of an athlete at the professional level, these types of patients are most motivated to do all that is necessary to return to play as soon as possible."The intensity and passion of the players is contagious, admitted Bollinger. They have a strong drive to return to the field when injured and they work hard during their rehab and fitness programs. "It is rewarding to see a player return to the field and know that you had a hand in it," he said.Dr. Bartolozzi noted the gratification he feels when reconstructing players' knees from torn ACLs, helping them through their injury and watching them return to play."Taking care of high-level athletes is rewarding, but I get a great satisfaction from working with my medical teammates," he confessed.

Sony Ericsson WTA Tour Player Blog

NEW HAVEN, CT, USA - Lisa Raymond has fond memories of New Haven. She is a two-time doubles winner here, winning in 1999 with Rennae Stubbs and last year with her current partner, Samantha Stosur; and in 2004, she made an exciting run to the singles semis The Philadelphia native is also in good spirits with the year's final major in New York, her favorite city, being just a week away. This week, Raymond brings us along with her Pilot Pen Tennis experience in the latest Sony Ericsson WTA Tour Player Blog.

Tuesday, August 22, 2006Hello again :-)It was another beautiful day here in New Haven. I took my usual walk down to Claire's for my coffee and paper. Now, the scary thing is that I had already had a cup of coffee before I even made it to Claire's. Actually, I had two! I LOVE my coffee. Sometimes I will wake up and I can't fall back asleep because I start thinking about coffee. The tournament hotel has coffee in the lobby starting at 6:30am. I usually get up, throw on some clothes and a hat, and head down to the lobby to get a cup (or two in my case this morning). I come back to the room, get online, check e-mails and enjoy drinking my first cup. THEN, I'll head out to Claire's and have breakfast, as well as more coffee. Do I have a problem? Another day, another win for the coach... I mean for Sam :-) She won her match today in three sets and is now in the quarters. She called me out at 5-4 down in the first set and we had our usual chat. This time, I actually did tell her a couple tactical things and she listened like a champ! She won the next two sets, 2 and 1. She is playing some great tennis, getting better with each match. Well done Sammy. The best news of the day was that we won our doubles match and my elbow felt great! What a relief. As I had said in earlier blogs I am not one who is used to being injured, so when I do get a little something, it makes me a bit nervous. Needless to say, we went out today and played a solid match, winning 3 and 1; and my elbow passed its first test! Very happy about that. Good job, Justin (my physio back home)and to the Sony Ericsson WTA Tour trainers this week! After the match, by the time we both showered and received treatment, we didn't get back to the hotel until 9pm. We dropped our gear and headed out to grab a quick bite. Both of us were still in tennis clothes, so we wanted something quick and casual. We ended up back at BAR, the place where the player party was. It was quick, easy, and yummy to say the least :-)Day off tomorrow for both of us. No singles, no doubles. Time to pack my bag for the day and then head to bed. Funny how all players have a special routine when packing their bag for the next day. Some do it the night before, some the day of. Me, I am a night before kind of girl. Practice clothes, match clothes, sweats, book, mags, toiletries, iPod, hats, flip flops, laundry bag... a lot to remember. It's all a part of the routine and we all have them...'til next time... Night :-)FYI... In case you were wondering, I downloaded "The Riddle" by Five for Fighting. It's worth a listen...